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A 74 year old woman visited a hospital complaining of right cervical lymphadenopathy. The cervical lymph node was removed and histology revealed non-caseating epithelioid cell granuloma, suspicious of Sarcoidosis. She was referred to our hospital for further examination. We diagnosed her as having sarcoidosis, based on biopsy of the right knee skin and findings of bronchoalveolar lavage fluid. Later, right cervical lymph node and parotid gland became enlarged. As she did not agree to take corticosteroids because she had diabetes mellitus, we chose Minocycline hydrochloride. Minocycline treatment induced the size reduction of cervical lymph node and parotid gland.A second biopsy of cervical lymph node was carried out with informed consent. Histopathology of lymph node revealed massive hyalinization with remnant of regressive granuloma and giant cells. Immunohistochemical study of monoclonal antibody against P. acnes lipoteichoic acid (PAB) revealed positive granules in the granuloma before Minocycline treatment, whereas PAB positive granules were found in giant cells around hyalinization and PAB had no reaction in the hyalinization after therapy.This case demonstrates that Minocycline induced reduction of granuloma but PAB positive granules remain, suggesting that Minocycline acts as an immunomodulator in addition to suppressing intracellular bacteria.
日本サルコイドーシス/肉芽腫性疾患学会の論文