IMMUNOLOGY OF SARCOIDOSIS

Cesar Boeck laid the cornerstones of sarcoid immunology with the ident ification of the noncaseating granuloma and the phenomenon of cutaneou s anergy to tuberculin. The paradoxical findings of spontaneous lympho blastic transformation and spontaneous lymphokine production led to th e discovery of immune hyper-reactivity in sarcoidosis. Since then, man y of the mechanisms of granuloma formation and cutaneous anergy have b een elucidated, and it appears that sarcoidosis is both initiated and driven by putative antigen. This antigenic activity has been localized by Kveim-Slitzbach skin test bioassay to the membranes of autologous sarcoid monocyte macrophages, suggesting that sarcoidosis is a unique, cell-mediated type of autoimmune disease.