Sarcoidosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Sarcoidosis is a diagnosis of exclusion of granulomatous lung diseases, including tuberculosis and histoplasmosis.
Typical history is essential to establish the diagnosis, and biopsy from affected organs is often required.
Treated with topical corticosteroids for mild local cutaneous disease. Systemic corticosteroids are the mainstay of treatment for severe disease. Immunomodulatory therapies are corticosteroid-sparing and can be used in the treatment of corticosteroid-refractory disease.
Poorer prognosis if black ancestry, chronic pulmonary involvement, lupus pernio, or chronic hypercalcemia.
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. Remission is not expected in patients with stage IV disease.

Bilateral hilar adenopathy

From the collection of Dr M.P. Muthiah; used with permission

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Bilateral hilar adenopathy
Photomicrograph showing well-formed granulomas typical for sarcoidosis
A) Gadolinium-enhanced MRI scan of the heart (short axis) showing delayed enhancement in the anteroseptal myocardium
B) 18F-FDG PET scan of the heart (short axis) showing focal uptake in the anteroseptal wall corresponding to granulomatous inflammation. (C) 18F-FDG PET scan of the heart (short axis) from the base to the apex (from left to the right) showing focal uptake in the anteroseptal wall at baseline (upper series) and disappearance of the uptake after treatment (lower series)

Citations

Key Articles

American Thoracic Society. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999 Aug;160(2):736-55.[Abstract][Full Text]
Thillai M, Atkins CP, Crawshaw A, et al. BTS clinical statement on pulmonary sarcoidosis. Thorax. 2021 Jan;76(1):4-20.[Abstract][Full Text]
Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and detection of sarcoidosis. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020 Apr 15;201(8):e26-51.[Abstract][Full Text]
Baughman RP, Valeyre D, Korsten P, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021 Dec;58(6):2004079.[Abstract][Full Text]

Other Online Resources

Foundation for Sarcoidosis Research

Referenced Articles

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