Black History of Health: Bernie Mac

Bernie Mac, comedian, writer, actor, and the world’s favorite uncle died in 2008 from pneumonia. Diagnosed with sarcoidosis or sarcoid in his 20s, he managed the condition through medication.

He was even in remission at the time of his death but it was said, however, that the pneumonia was due to immune system suppression caused by the same prescribed medicines for his sarcoid disease.

The mysterious illness is often misdiagnosed and much like the exact cause of Bernie’s death, it’s misunderstood. So, just what is sarcoid, who’s susceptible to it, and how can it be treated?

What is sarcoidosis?

According to the Foundation for Sarcoidosis Research (FSR), sarcoidosis, also known as sarcoid, is an unusual inflammatory disorder of unknown cause.

The inflammation it causes is also unusual in that it results in small nodules, called granulomas, which can join together to become larger nodules, and which can be present in a wide variety of organs, most typically the lungs. The nodules can interfere with normal organ function.

The process that forms these nodules is called granulomatous inflammation, and it is also seen in the infectious illness tuberculosis. However, it is unclear whether the microorganism responsible for TB, which is a mycobacterium, has any causative role in sarcoid.

In fact, while there are many theories and much research, the exact cause of sarcoid is still unknown.

Who’s susceptible to sarcoidosis?

The FSR reports that sarcoid typically strikes people between the ages of 20 and 40. It can affect either sex but it is 3-4 times more common, and often more severe, in Black people than it is in whites.

The lifetime risk of developing sarcoidosis in Black Americans in the United States is estimated at 2.4 percent while in whites it is 0.85 percent. In a small number of cases, more than one family member is affected. Interestingly, in about half the cases, the disease is noticed on a routine chest X-ray done for another reason, before any symptoms are present.

But since sarcoidosis typically affects the lungs (in at least 90 percent of cases), when symptoms do occur they are usually pulmonary in nature and include cough, difficulty breathing, and chest pain (which can range from a vague tightness to severe pain mimicking a heart attack). People may also experience fever, weakness, fatigue, and/or weight loss.

How is sarcoidosis treated?

Treatment is usually guided by symptoms, particularly worsening symptoms, such as shortness of breath or cough. Another cause for treatment would be decreasing pulmonary function even in the absence of pulmonary symptoms.

Steroids are the most typical treatment for sarcoid. In some cases inhaled or topical steroids may be sufficient to control mild disease, but in some cases, oral steroids are required.

Alternatives to steroids include the drugs methotrexate, cyclophosphamide, azathioprine, and hydroxychloroquine. In addition, some success has been had using the TNF inhibitors that were originally developed for the treatment of rheumatoid arthritis (but which are also effective for many inflammatory disorders including psoriasis and Crohn's disease), which include Enbrel, Humira, and Remicade.

All the drugs mentioned in this paragraph have significant potential for side effects, including infections, and their use must be monitored carefully.

Thankfully, the prognosis of sarcoidosis is typically positive. Many patients are asymptomatic and need no treatment. For some, the disease either resolves on its own or does not progress. Some have a more protracted or chronic course requiring treatment, but, barring complications, sarcoid is not usually a fatal illness.

BDO’s Black History of Health series is designed to show the correlation between the health of historical Black figures and Black Americans today. Many of the health disparities we currently experience have been in our community for centuries. This series is meant to bring these conditions to the forefront and provide blacks with preventative and management steps to reduce these disparities and improve the overall health of the Black American community. It’s time to change the narrative.