Cat litter is a possible trigger for sarcoidosis
This case stresses: ‘‘if you are not aware of it, you will not recognize it!’’
Obviously, she appeared to be ‘‘hypersensitive’’ not to the cats but to the cat litter
M. Drent* P.A. Wijnen, A.W. Bootsand A. Bast*
,
+*ILD Care Team, Depts of#Respiratory Medicine,
"
Clinical Chemistry, Maastricht University Medical Centre, and
+
Dept of Toxicology, University Maastricht, Maastricht, The Netherlands.
Sarcoidosis is characterised by cellular immune activity with
noncaseating granuloma formation in various organ systems
with a multifactorial cause. Many causative agents are con-
sidered to be involved in the pathogenesis [1–5]. Gene–
environment interactions offer the potential for strengthening
the evidence of causation between exposures and sarcoidosis. It
is important to identify every potential exposure to triggers in
order to avoid irreversible damage. Inorganic agents, including
silica, have been reported to initiate inflammation and granu-lomatous reactions .
It is well known that cats can cause
allergic reactions, but less is known about the association of
inflammation and cat litter. We propose that silica, the major
component of cat litter, might be such an agent.
We report a case of biopsy-proven sarcoidosis with birefringent material, mainly
silica, within the lung biopsy specimen. The patient had no
relevant occupational history, but had cats and was extensively
exposed to silica-containing cat litter. Initially, the patient
improved after starting immunosuppressive drugs and termi-
nating contact with litter. However, she deteriorated twice after
autoprovocation (re-exposure) to cat litter. After changing the
silica-containing cat litter for litter without silica, her clinical
condition improved substantially. Obviously, she appeared to
be ‘‘hypersensitive’’ not to the cats but to the cat litter
cat litter and sarcoidosis or a ‘‘sarcoid-like’’ granulomatous
reaction. Obviously, this is important, as many people have cats
with litter boxes. Therefore, it was recommended not to get rid of
the cats but rather choose appropriate cat litter, without silica.
This case stresses: ‘‘if you are not aware of it, you will not
recognise it!’’
http://erj.ersjournals.com/content/erj/39/1/221.full.pdf
