Microbial antigen treatment in sarcoidosis--a new paradigm?

Increasing evidence suggests that the risk for sarcoidosis is related to exposure to microbes, particularly molds. Microbial cell wall agents, even in the absence of clinical infection, could cause a late hypersensitivity reaction leading to the formation of granulomas. A few interventions studies using antimicrobial treatment demonstrate improvement in sarcoidosis. It is suggested that diagnostic tools for the presence of microbes are used in patients with sarcoidosis and that antimicrobial treatment is considered in cases resistant to corticosteroids.