Specific bronchoalveolar lavage fluid T cells associate with disease in a pair of monozygotic twins discordant for sarcoidosis

Grunewald J, Eklund A (Karolinska Hospital, Stockholm, Sweden). Specific bronchoalveolar lavage fluid T cells associate with disease in a pair of monozygotic twins discordant for sarcoidosis (Case report). J Intern Med 2001; 250: 535–539. A 49‐year‐old Caucasian woman had an acute onset of sarcoidosis. Bronchoscopy with bronchoalveolar lavage (BAL) showed a pronounced accumulation of BAL fluid CD4+ T cells expressing the T‐cell receptor (TCR) AV2S3 gene. In line with this observation, the patient was HLA‐DR17 positive, previously shown to strongly correlate with lung compartmentalized AV2S3+ T cells. At follow‐up after recovery, reduced numbers of BAL fluid AV2S3+ T cells were found. Interestingly, BAL fluid of a healthy monozygotic twin sister contained normal numbers of AV2S3+ lung T cells. This report shows the T‐cell repertoire of BAL fluid T cells to correlate with the disease (sarcoidosis), indicating a local and specific immune response triggered by an unknown antigen in sarcoidosis.