Sarcoidosis in Identical Twins

Abstract

The identical twins whose histories are recorded in this paper were found to have sarcoidosis.While under observation because of sarcoidosis one of them developed torulosis (cryptococcal infection).The presenting manifestation of this infection was osteitis of one scapula, and as this resolved there was at first some hope that the infection might run a benign course- recovery from localized torulosis has been recorded several times (see Gendel et al., 1950); eventually, how- ever, the patient died of cryptococcal meningitis. CASE REPORTSThe twins were born in 1921.They had no brothers or sisters.Their father died of asthma and pneumonia at the age of 36, their mother of coronary thrombosis when 62. Except during the war, and from 1948 to 1952, the twins lived together in Kent.Both served in North Africa during the war, and the first twin also spent some time in India. First Twin-Sarcoidosis Complicated by TorulosisThis man, who was employed in an estate agency, married in 1946.In January, 1952, his wife had a small haemo- ptysis: radiography showed small, partly calcified lesions in the apical part of each-lung; tubercle bacilli were found in films of one specimen of sputum, and once subsequently in gastric washings.She was treated conservatively in a sanatorium, made a good recovery, and remains in good health.A radiograph of her husband's chest in February, 1952, showed some mottling of both lung fields.He was advised to come into hospital for investigation; as he had no svmptoms he delayed doing so until January, 1954.First Admission (January 7 to February 13, 1954) The only clinical abnormalities were two small, soft, mobile lymph nodes in the right supraclavicular fossa and one in the right axilla, very large but clean tonsils, and a nodule, about 0.5 cm. in diameter, in the skin over the fifth left costochondral junction.The scar of an inguinal herniorrhaphy, which had been performed in childhood.was healthy.Investigations.-Chest radiograph (Special Plate, Fig. 1): extensive infiltration in lungs, predominantly in middle and lower zones; no obvious hilar enlargement.Mantoux reaction negative (0.2 ml. of 1:10 old tuberculin).Serum albumin 5.5 g., globulin 3.7 g. per 100 ml.Hb 14.9 g. *These patients were mentioned briefly by Littman and Zimmerman (1956) on p. 37 of their monograph on torulosis.