SARCOIDOSIS IN IDENTICAL-TWINS

Identical (monozygotic) female twins both simultaneously developed acu te sarcoidosis with unusual manifestations. Additional to pulmonary in volvement they both also had hypercalcaemia with compensated renal fai lure. When seen at the age of 33 years, these findings were more marke d in one. of them (case 2) than in the other, and she also had granulo matous conjunctivitis, while in the other one (case 1) the dominant si gn was widespread lymph node enlargement. Both were also found by magn etic resonance imaging to have multiple lesions in the white matter, i nterpreted as the morphological correlate of neurosarcoidosis. But the y caused clinical symptoms (visual disorder, unsteady gait) in only on e sister (case 1). Treatment with prednisolone largely normalized the lung functions in case 2, completely in case 1, and renal functions in both. But when the daily prednisolone dose was reduced to below 10 mg , the pulmonary symptoms recurred. - These observation's indicate that even in chronic sarcoidosis acute episodes may occur, with involvemen t of multiple organs and other rare complications. The manifestations of the underlying disease in identical twins and the similarities of i ts course in the two sisters underline the possible role of genetic fa ctors in the pathogenesis of