Wonder Drake, MD: Sarcoidosis is a Disease of Exclusion


Sarcoidosis expert Dr. Wonder Drake got into the field after diagnosing a patient with the disease early in her career. In this interview she explains the best way to approach a suspected case of sarcoidosis.

Wonder Drake, MD, is a professor of medicine in the Division of Infectious Diseases at Vanderbilt University Medical Center (VUMC), and she serves on the Foundation for Sarcoidosis Research (FSR) Scientific Advisory Board. She's also the director of the university's Sarcoidosis Center of Excellence, as well as a member of the World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG) executive committee.

Drake chose sarcoidosis research to be the focus of her career because she wanted to further the understanding of sarcoid pathogenesis. When she realized that a patient she was treating had the disease it made her wonder, "could we develop something that would have cured it?"

"It just really impacted me that a disease could just take this young person who, you know, was married and working hard with 2 little kids, and I'm about to put them on disability," she said.

Sarcoidosis is a rare disease that's characterized by the growth of granulomas, or collections of tiny inflammatory cells, throughout the body. They often present in a patient's lungs and lymph nodes but can also affect the eyes, skin and heart.

The incidience of the disease within the US falls among African Americans, with a particularly heavy burdern on African American women. According to Drake, this suggests that not only are genetics an important factor, but hormone status is too.

Because there's no straightforward test to determine a diagnosis, it can be difficult to detect. When Drake's patient first presented with fatigue and weight loss, she initially suspected HIV but it turned out that he had sarcoidosis involvement in his kidneys and was going into renal failure.

"It's tough," she said, "because the disease is a disease of exclusion."

Drake approaches a suspected case of sarcoidosis by ruling out other possibilities like infections, cancers and lymphomas that can also cause granulomas.

"So, you really just rule out all these other diagnoses and then if the clinical picture fits, then you tell the patient that they have sarcoidosis," she said.

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