Immunology of sarcoidosis

Cesar Boeck laid the cornerstones of sarcoid immunology with the identification of the noncaseating granuloma and the phenomenon of cutaneous anergy to tuberculin. The paradoxical findings of spontaneous lymphoblastic transformation and spontaneous lymphokine production led to the discovery of immune hyper-reactivity in sarcoidosis. Since then, many of the mechanisms of granuloma formation and cutaneous anergy have been 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.