ABSTRACT
Controlled Etiologic Study of Sarcoidosis (ACCESS) has been concluded (1). This uniquely objective, rigidly controlled, expensive study failed in
its primary goal, i.e., to find the cause of sarcoidosis. This is an appropriate
juncture to consider whether the search for the etiology of sarcoidosis is
worth the required time and resources or should this effort be applied else-
where. We are coming to the end of a 100 year era hailing a long list of puta-
tive etiologic agents in sarcoidosis-alas, none of them proven. Some of
these presumed triggers are based on narrow epidemologic data, others
were suggested by similarity to clinical entities with known causative agents, and still others by demonstration of a suspect particle or organism in tissue
or body fluid. All have been found wanting by more rigid epidemiologic,
bacteriologic, and immunologic criteria. With the recent discovery of speci-
fic organisms which cause peptic ulcer disease and Whipple’s disease, there
has been an added impetus to search for occult etiologic agents in many dis-
eases, including sarcoidosis. Importantly, identification of species’ DNA
utilizing polymerase chain reaction (PCR), has augmented the list of sus-
pects or has buttressed the claims of early investigators. The past decade has spawned a spate of manuscripts claiming PCR evidence for a variety
of proposed etiologic agents in sarcoidosis. However, the conflicting reports concerning mycobacteria, propionibacteria, and other organisms have given
rise to a general sense that we continue to run in place, failing to grasp the
elusive brass ring, despite the expenditure of considerable time and money.
