Sarcoid-like reactions (SLRs) or autonomous sarcoidosis (AS)? Differentiation probably important?
To the Editors,
Baughman et al. informed about the results of the application of various therapeutic regimens in patients with the autonomous disease sarcoidosis. The new definitions and recent assumptions or perceptions of sarcoidosis and sarcoid-type reactions, however, should also be consistent with the subsequent introduction of one or another type of systemic or/and local therapy. The lack of uniform (inclusion or exclusion) criteria for the definition of the disease such as sarcoidosis or sarcoid type of reaction in the study presented, would not only result (in the case of the proposed by authors regimens) to the progression of the sarcoid-type reaction (within the immunological response to certain infectious or non-infectious but still immunogenic antigens), but also to the progression of a certain type of tumors within the frame of the so-called paraneoplastic type of sarcoid reaction. The introduction of immunosuppressive therapy with azathioprine, methotrexate, or corticosteroids often appears to play an important role as a costimulatory factor for carcinogenesis due to the fact that such therapy limits the ability of the immune system to eliminate tumor cells and thus indirectly support the tumor-escape mechanisms. This explains why at later stages in the described patients, different tumor types are often registered and the patients’ condition is usually described as sarcoidosis—associated with a type of tumor. In practice, these cases are concerned with the paraneoplastic form of sarcoid-type reaction, occurred on the basis of molecular mimicry due to a cross mediated immunoreactivity.