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July 25, 1977

Histoplasmosis vs Sarcoidosis

Author Affiliations

Veterans Administration Hospital Sepulveda, Calif

JAMA. 1977;238(4):304. doi:10.1001/jama.1977.03280040024006

To the Editor.—  Walker et al (237:1350-1352, 1977) described a patient with histoplasmosis in whom noncaseating granulomas were seen. They emphasized the fact that it is sometimes difficult to determine the origin of such granulomas or to distinguish between sarcoidosis and disseminated histoplasmosis. This is certainly true, although much assistance can now be obtained by an assay of serum angiotensin-converting enzyme (ACE). The association of elevated serum ACE levels with active sarcoidosis was fully reported in 19751-3 and has since been confirmed by a number of authors. Elevated levels as seen in sarcoidosis do not usually occur in patients with those mycobacterial or fungal lung diseases that enter into the differential diagnosis of sarcoidosis. For example, we found only one of 15 patients with disseminated coccidiodomycosis to have an elevation of serum ACE,4 and this one case brings under consideration the possibility of coexistent sarcoidosis and pulmonary fungal