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Sarcoidosis

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"Sarcoidosis"[MeSH Terms]

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sarcoidosis NIH overview diagnosis treatment

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https://www.ncbi.nlm.nih.gov/books/NBK430687

Sarcoidosis is an inflammatory, multisystem disease in which the immune system forms noncaseating granulomas, small collections of inflammatory cells, in organs. Its cause is unknown. It most often affects the lungs and intrathoracic lymph nodes, but can involve the skin, eyes, heart, nervous system, liver, kidneys, and joints. - Textbook of Family Medicine, p. 952

Typical features

  • Lungs: dry cough, breathlessness, chest discomfort, or no symptoms
  • Chest imaging: bilateral hilar lymph-node enlargement, sometimes lung infiltrates or fibrosis
  • Skin: red-brown papules/plaques, erythema nodosum (tender shin nodules), or lupus pernio around the nose
  • Eyes: uveitis, eye pain/redness, light sensitivity, blurred vision
  • Joints: ankle arthritis or swelling
  • Heart or nervous system: less common, but potentially serious
Löfgren syndrome is a relatively acute presentation with bilateral hilar lymphadenopathy, erythema nodosum, fever, and arthritis. It often has a favorable prognosis. - Dermatology 2-Volume Set 5e, p. 1267

Diagnosis

Diagnosis is based on:
  1. Compatible clinical and imaging findings
  2. Biopsy showing noncaseating granulomas, when needed
  3. Excluding other granulomatous illnesses, particularly tuberculosis and fungal infection
Tests may include chest X-ray or CT, pulmonary-function tests, ECG, blood and urine tests, eye examination, and biopsy of an accessible lymph node, skin lesion, or lung site. Serum ACE can support the picture but cannot diagnose or exclude sarcoidosis by itself. The NIH clinical review describes the role of imaging, tissue confirmation, and exclusion of infection.

Treatment

Many patients with mild disease need observation only, since spontaneous improvement is common. Treatment is considered when disease is progressive, symptomatic, or threatens organ function, especially involving the eyes, heart, brain, kidneys, or significant lung impairment.
  • Corticosteroids, usually prednisone, are first-line when treatment is needed.
  • Steroid-sparing drugs may be used for persistent disease, such as methotrexate, azathioprine, hydroxychloroquine, or, in selected refractory cases, anti-TNF therapy.
  • Follow-up commonly includes symptoms, lung function, imaging, and organ-specific monitoring.
For cutaneous disease, intralesional or systemic corticosteroids may be used; hydroxychloroquine or methotrexate can be options in difficult cases. - Textbook of Family Medicine, p. 952

Seek prompt medical assessment if there is

  • New fainting, palpitations, chest pain, or unexplained slow heartbeat
  • New visual loss, severe eye pain, or marked redness/light sensitivity
  • Severe or worsening breathlessness
  • New weakness, seizures, severe headache, or facial paralysis
Sarcoidosis should be assessed by a clinician because the necessary tests and urgency depend on the organs involved.
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