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Marshall Plan as Sarcoidosis Treatment

01/26/2007

Question:

I am a 21 year old male who was recently diagnosed with sarcoidosis. The advent of the disease remains a mystery to me though I had long suffered from a sporadic rash. The diagnosis was finalized by my physician following a CT scan revealing 5 lung nodules ranging in size present in my right lung and a blood test indicating an elevated ACE level. Aside from the rash mentioned earlier I do experience some pain in my ankle and knee joints. Additionally I have taken note of some granulomas present under my skin. I do not however, have any pulmonary complications. My physician has opted to treat me with 60 mg doses of prednisone for three months.

I opted to conduct a little research in regards to the disease and came across a website in which an individual by the name of Trevor Marshall has claimed to discover the root cause of the disease and has outlined a treatment plan based upon it. It seems quite promising.

I was hoping that you could provide me with your input in regards to the plan.

The website is http://www.marshallprotocol.com/

Answer:

Dear Sir-

I am aware of the "Marshall plan" for treating sarcoidosis, and the results sound compelling on the basis of a few limited studies.  However, this treatment has not been validated in a large and well-designed clinical trial, and it has not been adopted as a common treatment for sarcoidosis. 

Moreover, certain antibiotics, including the ones Marshall's group uses to treat sarcoidosis, can alter the immune responses independent of the drug's antimicrobial actions.  Thus, I can only say that this protocol sounds promising, but needs to be validated before it can be recommended to doctors and patients as a helpful treatment for sarcoidosis. 
 
As for your current treatment, 60 mg of prednisone a day for 3 months seems like a high dose.  This being said, the dose needs to be tailored to the severity of your disease.  I presume, based upon this dosing regimen, that your doctor felt that you had a "severe case" of sarcoidosis. 
 
If you require long-term treatment with more than 20 mg a day of prednisone to control your sarcoidosis, other drugs should be considered (usually in addition to prednisone) so that you can avoid the adverse side effects of sustained high dose prednisone exposure.  It is best to recruit a specialist who is experienced in the management of sarcoidosis to participate in your care.
 
Sincerely yours,

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University