Sarcoidosis is a diagnosis of exclusion of granulomatous lung diseases, including tuberculosis and histoplasmosis.
Typical history and biopsy from affected organs are essential for the diagnosis.
Treated with topical corticosteroids for mild local cutaneous disease. Systemic corticosteroids are the mainstay of treatment for severe disease.
Carries a mortality of 1% to 6%.
Poorer prognosis if black ancestry, chronic pulmonary involvement, lupus pernio, or chronic hypercalcaemia.
Spontaneous remissions occur in 55% to 90% of patients with stage I, 40% to 70% of patients with stage II, and about 20% of patients with stage III disease, but no remissions are expected in stage IV.
Sarcoidosis is a chronic granulomatous disorder of unknown aetiology, commonly affecting the lungs, skin, and eyes. It is characterised by accumulation of lymphocytes and macrophages and the formation of non-caseating granulomas in the lungs and other organs. Although lungs and lymph nodes are involved in more than 90% of patients, virtually any organ can be involved. It has a bimodal age distribution with 2 peaks in the third and fifth decades. The clinical course is often heterogeneous and unpredictable.
History and exam
Key diagnostic factors
- chronic fatigue
- red painful eye
- blurred vision
- erythema nodosum
- lupus pernio
- conjunctival nodules
- facial palsy
Other diagnostic factors
- absent history of exposure to beryllium
- chest wall pain
- weight loss
- low-grade fever
- heart block
- symptoms and signs of pituitary lesion
- age 20 to 40 years
- FHx sarcoidosis
- female gender
- black ancestry (US): uveitis
- Scandinavian origin
- Puerto Rican origin: lupus pernio
- European origin: erythema nodosum
1st investigations to order
- serum urea
- liver enzymes
- serum calcium
- purified protein derivative of tuberculin (PPD)
Investigations to consider
- CT scan of chest
- flexible bronchoscopy with transbronchial lung biopsy
- bronchoalveolar lavage (BAL)
- skin biopsy
- 24-hour urine calcium
- serum ACE
- gallium-67 scan
- endobronchial ultrasound-transbronchial needle aspiration
- (18)F-fluorodeoxyglucose (FDG) PET scan
acute respiratory failure unable to tolerate oral intake
acute respiratory failure able to tolerate oral intake
CNS, peripheral nervous system, or cardiovascular involvement
- Non-small cell lung cancer
- Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal masses
- Statement on sarcoidosis
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