Abstract Rationale Sarcoidosis is a multisystem granulomatous disease that commonly affects the lungs and hilar lymph nodes, with peak incidence in adults aged 30-55. Although has unclear etiology, prior research has linked environmental and occupational exposures: mold, dust, silica, metalwork, firefighting, and insecticides to increased risk. Veterans may be particularly vulnerable due to unique exposures encountered during military service, including burn pits, shipyards, and convoy operations. Studies have shown a higher prevalence of sarcoidosis among veterans compared to the general population. This study explores the exposure histories of veterans with sarcoidosis who received care at our institution, aiming to better understand potential contributing factors. Methods We identified patients from the Baltimore VA Medical Center who were discussed in pulmonary tumor board from 1/2023 - 8/2025 and who had evidence of granulomatous inflammation on lung or lymph node biopsy without a pathologic diagnosis of carcinoma, fungal infection, or tuberculosis. Results We identified a total of 21/100 veterans and collected information on age, sex, race, inhalation, military and occupational exposures, tuberculosis history, and use of TNF-a inhibitors and amiodarone. Results The mean age of our cohort was 68 years old with a 20:1 M/F distribution. 48% identified as white, 38% black, 5% white-Hispanic, and 10% declined to answer. 48% had 30 pack-year smoking history while 29% were never smokers. 43% served during the Vietnam War era, 29% Persian Gulf War era, 24% post-Vietnam War era, and 5% post-Korean War era. Military exposures were documented in 71% of this cohort and included 19% asbestos, 14% agent orange, 14% jet/diesel fumes, 10% burn pits, two cases of Camp Lejeune, one case of insecticides, and one case of nuclear materials. Post active service occupational exposures were also reported in 43% of this cohort and notable for working with soldering, asbestos, and jet/diesel fumes. One veteran was treated for latent tuberculosis, and no veterans had documented TNF alpha inhibitor or amiodarone use. Conclusions Veterans at the Baltimore VA Medical Center have a higher incidence of granulomatosis inflammation due to sarcoidosis than the general population. Although no clear causal relationship exists between military exposures, the most common exposure identified for this small cohort was asbestos in both military and occupational settings followed by diesel fumes and agent orange in the military cohort. We suspect veterans having worked with known foreign antigen and inorganic triggers leads to a higher prevalence of sarcoidosis. This abstract is funded by: None
Deepak et al. (Fri,) studied this question.