Broncho-alveolar lavage in sarcoidosis. Correlation between alveolar lymphocytosis and clinical data

Bronchoalveolar lavages (BAL) were performed in patients with pulmonary sarcoidosis and in normal subjects. In both smoking and nonsmoking sarcoid patients, the proportion and number of lymphocytes were significantly increased compared to corresponding controls (p less than 0.001 in each cases). BAL lymphocytes were identified as T lymphocytes (88 +/- 9% formed E rosettes). Neither the radiological stage, nor the duration of disease are related to the lymphocyte number. However, alveolar lymphocytosis is significantly correlated with clinical pattern (p less than 0.02) and with clinical extrathoracic dissemination (p less than 0.001). Black patients have significantly more disseminated disease than Whites (p less than 0.001). The lymphocytosis of the bronchoalveolar space is associated with the presence of granulomas in bronchial biopsies (p less than 0.005). For clinical purposes, the results of BAL were helpful in determining the evolutivity of the disease, particularly progression to stage III. Together with a high lymphocyte count, a significant increase of all the polymorphonuclear leukocytes (PMNL) was found in stage III (4.0 +/- 4.6 X 10(4) PMNL/ml, p less than 0.001) compared to earlier stages (respectively 0.6 +/- 0.5 X 10(4), 0.7 +/- 0.9 X 10(4) and 0.7 +/- 0.9 X 10(4) PMNL/ml for stages I, IIA and IIB). BAL may also be used to follow up sarcoid patients. Repeated BAL were performed in 23 patients. No modification in alveolar lymphocytosis is found in patients with steady state disease, but, in healed patients the lymphocyte number returns to normal.