Sarcoidosis

A disease of unknown cause in which inflammation consisting of granulomas occurs in lymph nodes, lungs, liver, eyes, skin, or other tissues.

Causes, incidence, and risk factors

The cause of the disease is unknown. Tissue samples from involved organs show granulomas, which are clusters of macrophages, lymphocytes, and cells called multinucleated giant cells. Possible causes include a hypersensitivity response, a genetic predisposition, infection, or chemicals. The incidence varies widely according to race and sex. Incidence is highest among North Americans of African heritage and Northern European Caucasians. Women of African heritage are affected more than men of African heritage. The onset of the disease usually occurs in people between 30 and 50 years old. Sarcoidosis is very rare in young children.

Signs and tests

  • CBC
  • Chem-7
  • or
    • chem-20
  • ACE levels
  • Chest X-ray
  • looking for lung involvement or enlargement of the lymph nodes (hilar adenopathy)
  • Lymph node biopsy
  • Skin lesion biopsy
  • Bronchoscopy
  • Open lung biopsy
  • Liver biopsy
  • Kidney biopsy
  • EKG looking for heart involvement
    • This disease may also alter the results of the following tests:
  • Quantitative immunoglobulins (nephelometry)
  • PTH
  • Liver function tests
  • Serum phosphorus
  • Nerve biopsy
  • Mediastinoscopy with biopsy
  • Lung gallium (Ga.) scan
  • Immunoelectrophoresis - serum
  • Calcium; urine
  • Calcium (ionized)
  • Serum calcium

    • Treatment

  • Sarcoidosis symptoms often gradually resolve on their own without treatment. Individuals who are more severely affected require treatment with corticosteroids. Therapy may continue for 1 or 2 years, although some affected may require life-long therapy. Other drugs sometimes used in addition to corticosteroids are immunosuppressive agents such as methotrexate, azathioprine, and cyclophosphamide. Rarely some individuals with irreversible organ failure require organ transplantation.

    • Expectations (prognosis)

    Many people are not seriously ill, and the disease may resolve without treatment. Thirty to fifty percent of cases resolve without treatment in 3 years. About 20% of those with lung involvement will develop residual lung damage. Death from sarcoidosis is very rare in the first several years with the disease and remains uncommon thereafter.

    Complications

  • Diffuse interstitial pulmonary fibrosis
  • Pulmonary hypertension
  • Anterior uveitis
  • Glaucoma
  • and
    • blindness (rare)
  • Cardiac
    • arrhythmias
  • Cranial or
    • peripheral nerve palsies
  • Kidney stones

    • Calling your health care provider

    Call your health care provider if difficulty breathing , vision changes, palpitations , or other symptoms develop.

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