Sarcoidosis and burn pit exposure in military deployers to Iraq, Afghanistan, and Southwest Asia Sarcoidosis in military personnel

Main Article Content

Divya Patel
Johnny Jaber
Jennifer Loso
Hassan Perera
Salim Daouk
Ayoub Innabi
Diana Gomez-Manjarres
Silpa Krefft
Robert Miller

Keywords

sarcoidosis, burn pits, military, veterans, desert dust

Abstract

Background and aim: Inhalational exposures have been hypothesized to play a role in the pathogenesis of sarcoidosis. Herein, we describe a cohort of US Military personnel diagnosed with sarcoidosis during or after deployment to Southwest Asia and Afghanistan, who experienced complex inhalational exposures to burn-pits and desert dust.


Methods: Consecutive military personnel at four sub-specialty clinics across the United States were screened for deployment to Southwest Asia and Afghanistan and diagnosis of sarcoidosis based on 1999 ATS/ERS/WASOG Statement on Sarcoidosis. Detailed demographic, deployment and exposure data was collected. The data combined was analyzed after de-identification and local IRB approval.


Results: Twenty-one patients met our case definition. Seventeen patients were male and 62% had extrapulmonary involvement, including 38% with musculoskeletal involvement. 


Conclusions: Our study suggests that the sarcoidosis in military personnel to Southwest Asia can be diagnosed many years after deployment. To our knowledge, this is the first case series to describe a group of military personnel diagnosed with sarcoidosis and exposures specific to military deployment to Southwest Asia.

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References

1. Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020 Apr 15;201(8):e26–51.
2. Newman LS, Rose CS, Bresnitz EA, Rossman MD, Barnard J, Frederick M, et al. A case control etiologic study of sarcoidosis: environmental and occupational risk factors. Am J Respir Crit Care Med. 2004 Dec 15;170(12):1324–30.
3. Barnard J, Rose C, Newman L, Canner M, Martyny J, McCammon C, et al. Job and industry classifications associated with sarcoidosis in A Case-Control Etiologic Study of Sarcoidosis (ACCESS). J Occup Environ Med. 2005 Mar;47(3):226–34.
4. Kreider ME, Christie JD, Thompson B, Newman L, Rose C, Barnard J, et al. Relationship of environmental exposures to the clinical phenotype of sarcoidosis. Chest. 2005 Jul;128(1):207–15.
5. Liu H, Patel D, Welch AM, Wilson C, Mroz MM, Li L, et al. Association Between Occupational Exposures and Sarcoidosis: An Analysis From Death Certificates in the United States, 1988-1999. Chest. 2016 Aug;150(2):289–98.
6. Izbicki G, Chavko R, Banauch GI, Weiden MD, Berger KI, Aldrich TK, et al. World Trade Center “sarcoid-like” granulomatous pulmonary disease in New York City Fire Department rescue workers. Chest. 2007 May;131(5):1414–23.
7. Garshick E, Abraham JH, Baird CP, Ciminera P, Downey GP, Falvo MJ, et al. Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2019 Aug;16(8):e1–16.
8. Szema AM. Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan. Occup Med Health Aff. 2013;1.
9. Szema A, Mirsaidi N, Patel B, Viens L, Forsyth E, Li J, et al. Proposed Iraq/Afghanistan War-Lung Injury (IAW-LI) Clinical Practice Recommendations: National Academy of Sciences’ Institute of Medicine Burn Pits Workshop. Am J Mens Health. 2017 Nov;11(6):1653–63.
10. Smith B, Wong CA, Smith TC, Boyko EJ, Gackstetter GD. Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: a prospective population-based study. Am J Epidemiol. 2009 Dec 1;170(11):1433–42.
11. Pugh MJ, Jaramillo CA, Leung KW, Faverio P, Fleming N, Mortensen E, et al. Increasing Prevalence of Chronic Lung Disease in Veterans of the Wars in Iraq and Afghanistan. Mil Med. 2016 May;181(5):476–81.
12. Baird CP. Review of the Institute of Medicine report: long-term health consequences of exposure to burn pits in Iraq and Afghanistan. US Army Med Dep J. 2012 Sep;43–7.
13. Dursa EK, Barth SK, Schneiderman AI, Bossarte RM. Physical and Mental Health Status of Gulf War and Gulf Era Veterans: Results From a Large Population-Based Epidemiological Study. J Occup Environ Med. 2016 Jan;58(1):41–6.
14. Falvo MJ, Osinubi OY, Sotolongo AM, Helmer DA. Airborne hazards exposure and respiratory health of Iraq and Afghanistan veterans. Epidemiol Rev. 2015;37:116–30.
15. Kelsall HL, Sim MR, Forbes AB, McKenzie DP, Glass DC, Ikin JF, et al. Respiratory health status of Australian veterans of the 1991 Gulf War and the effects of exposure to oil fire smoke and dust storms. Thorax. 2004 Oct;59(10):897–903.
16. King MS, Eisenberg R, Newman JH, Tolle JJ, Harrell FEJ, Nian H, et al. Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med. 2011 Jul 21;365(3):222–30.
17. Madar CS, Lewin-Smith MR, Franks TJ, Harley RA, Klaric JS, Morris MJ. Histological Diagnoses of Military Personnel Undergoing Lung Biopsy After Deployment to Southwest Asia. Lung. 2017 Aug;195(4):507–15.
18. Wu M, Gordon RE, Herbert R, Padilla M, Moline J, Mendelson D, et al. Case report: Lung disease in World Trade Center responders exposed to dust and smoke: carbon nanotubes found in the lungs of World Trade Center patients and dust samples. Environ Health Perspect. 2010 Apr;118(4):499–504.
19. Judson MA, Costabel U, Drent M, Wells A, Maier L, Koth L, et al. The WASOG Sarcoidosis Organ Assessment Instrument: An update of a previous clinical tool. Sarcoidosis, Vasculitis and Diffuse Lung Diseases. 2014 Apr 18;31(1):19–27.
20. Crapo RO, Morris AH, Gardner RM. Reference Spirometric Values Using Techniques and Equipment that Meet ATS Recommendations. Am Rev Respir Dis. 1981 Jun;123(6):659–64.
21. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric Reference Values from a Sample of the General U.S. Population. Am J Respir Crit Care Med. 1999 Jan;159(1):179–87.
22. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 1):1885–9.
23. Coker WJ, Bhatt BM, Blatchley NF, Graham JT. Clinical findings for the first 1000 Gulf war veterans in the Ministry of Defence’s medical assessment programme. BMJ. 1999 Jan 30;318(7179):290–4.
24. Parrish SC, Lin TK, Sicignano NM, Lazarus AA. Sarcoidosis in the United States Military Health System. Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(3):261–7.
25. Rep. Takano M [D C 41. Text - H.R.3967 - 117th Congress (2021-2022): Honoring our PACT Act of 2022 [Internet]. 2022 [cited 2023 Jun 8]. Available from: http://www.congress.gov/bill/117th-congress/house-bill/3967/text/pcs