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Pleural Effusions in a Series of 181 Outpatients With Sarcoidosis^*

^* From the Department of Allergy and Clinical Immunology (Drs. Huggins, Doelken, Sahn, and Judson), Division of Pulmonary and Critical Care Medicine, and the Department of Biometry (Ms. King), Medical University of South Carolina, Charleston, SC.

Correspondence to: John T. Huggins, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, PO Box 250625, Charleston, SC 29425; e-mail: hugginjt{at}musc.edu

Abstract

Objectives: Pleural effusion (PE) is considered to be a rare manifestation of pulmonary sarcoidosis. We performed thoracic ultrasonography prospectively in consecutive outpatients with sarcoidosis to determine the frequency of PEs caused by sarcoidosis and to define their pleural fluid characteristics.

Design: Consecutive outpatients aged 18 years with biopsy-proven sarcoidosis underwent ultrasonography.

Setting: University hospital, outpatient sarcoidosis clinic.

Results: One hundred eighty-one outpatients were enrolled into the study. The subjects were predominately African-American and female. Most were between 30 and 60 years of age. The Scadding radiograph stages were fairly evenly distributed across all five stages (0 through 4). Five (2.8%) of 181 patients were found to have pleural fluid. Two patients had a unilateral left-sided PE, and three patients had bilateral PEs. Pleural fluid analysis (PFA) was performed in four patients. The PFA showed a lymphocyte-predominant exudate using protein criterion in only two patients, which is consistent with sarcoidosis-related PE; one patient underwent pleural biopsy, which was consistent with the diagnosis of sarcoidosis. A sarcoidosis-related PE was seen in 1 of 9 patients (11.1%) who had an exacerbation of pulmonary sarcoidosis compared to 1 of 172 patients (0.6%) who did not have an exacerbation (p < 0.4).

Conclusion: PEs are rare in outpatients with sarcoidosis, even when a sensitive technique, such as ultrasonography, is used. The frequency of PEs was 2.8% (5 of 181 patients) with only 2 of the 181 PEs (1.1%) caused by sarcoid pleural involvement. PE in patients with sarcoidosis should not be assumed to be related to sarcoidosis. Discordance between levels of pleural fluid total protein and lactate dehydrogenase may be a characteristic finding in patients with sarcoid PE. An exacerbation of pulmonary sarcoidosis was not an independent risk factor for the development of sarcoid-related PE.

Key Words: pathogenesis • pleural effusion • prevalence • sarcoidosis • ultrasonography