Sarcoidosis and aspergillosis: a tough combination.

It should have been a wake-up call. Thirty years ago, TOMLINSON and SAHN [1] found that seven out of 12 (58%) patients with aspergillosis complicating sarcoidosis died over a 2 year period. Three years earlier, WOLLSCHLAGER and KHAN [2] had found evidence of aspergillosis in 12% of 100 consecutive sarcoidosis referrals, and aspergillomas were found in 53% of the 19 patients with fibrocystic aspergillosis. Yet the literature was almost silent on this topic despite an estimated global prevalence of 1.2 million patients with sarcoidosis [3], until 2008. In that year, HOURS et al. [4] surveyed pulmonary cavitary sarcoidosis and its complications in their tertiary care service for sarcoidosis in Paris, France. They found that 3.9% had cavitary lesions and 2.1% an aspergilloma. This team have followed that report up in this issue of the European Respiratory Journal with a detailed study of chronic pulmonary aspergillosis complicating pulmonary sarcoidosis [5]. Others have noted the complexity of this dual pulmonary condition [6].