Sarcoidosis is an inflammatory condition affecting multiple organs of the body. Specific finding of non-caseating granulomas on biopsy usually lead to confirmation of the diagnosis. The cause of sarcoidosis is not known - but could be related to environmental exposures, reaction to some bacteria or a genetic predisposition.
Sarcoidosis affects young/middle-aged adults. The organs involved may include: lymph nodes in chest, lungs, eyes, skin or other vital organs (heart, nervous system, liver etc.).
Up to half of patients have no symptoms when diagnosed. Those who do, can have general non-specific symptoms: tiredness, fever, weight loss, night sweats, chest and joint pain. More specific symptoms depending on the organ involved may be present: breathlessness, cough, wheeze (lung) / palpitations (heart) / skin rashes and nodules (skin).
The diagnosis is made based on a combination of compatible symptoms, certain patterns on chest imaging, ruling out other conditions, biopsy from an accessible organ (skin, lymph node etc.). Certain blood tests can support this diagnosis diagnosis (low lymphocytes / high ACE levels / high calcium). Other tests to evaluate organ involvement may also be done: ECG or 24-hour ECG monitor, urine tests, eye exam, ultrasound of the heart or liver, MRI scans, nerve conduction studies.
The prognosis can be variable, and many patients improve without treatment. However, treatment is required if there is vital organ involvement and progression (heart, nervous system, liver), when blood calcium levels are very high, or when the symptoms are unbearable.
Treatment is usually with antiinflammatory drugs (corticosteroids such as prednisolone) or a corticosteroid-sparing drug such as methotrexate, azathioprine, hydroxichlorquine. Treatment is usually for at least 12 months.
Sarcoidosis needs careful monitoring over time.
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