Most common clinical presentations are : - persistent cough,
- localization of disease in the skin,
- eye, and
- peripheral lymph nodes,
- erythema nodosum,
- fatigue, and
- incidental abnormal chest radiograph
DDx - infections, particularly tuberculosis;
- occupationally
induced, environmentally induced, and drug-induced
granulomatosis; chronic pulmonary berylliosis is dependent on a focused questionnaire and on beryllium hypersensitivity
- common variable immune deficiency. Diagnosis of common variable immune deficiency relies on hypogammaglobulinaemia,
- Blau’s syndrome;
- sarcoid-like reactions in cancers and
lymphomas, and
- other idiopathic granulomatosis.
Three most important advancement in diagnosis has been: - PET scan
- Rapid on-site assessment by the well trained cytologists
- EUS guided Needle aspirations
Diagnosis is based on the following. The weight of each of them depends on the clinical scenarios. - Clinical Picture and Radiological Picture
- Caseating granulomas, and
- evidence of no alternative findings
Most common diagnostic signs are - bilateral
intrathoracic hilar lymphadenopathy or diffuse
micronodular pulmonary infiltration at chest radiograph,
- associated with a typical lymphatic distribution or a
galaxy sign on CT and
- the presence of some
extrapulmonary localisations of disease—eg, in the eye
and skin
Sarcoidosis Lancet 2014
Sarcoidosis Lancet 2014
- Constitutional symptoms such as fatigue may predominate.
- Cardiac sarcoidosis is much more common than reported previously and may cause loss of ventricular function and
sudden death.
- Cardiac and neurologic sarcoidosis may occur without apparent disease activity in other organs.
- Chest radiographic patterns (stages 1, 2, and 3) do not reflect the chronology of the disease.
-
- A response to corticosteroid therapy does not establish the diagnosis of sarcoidosis.
- Measurement of the serum angiotensin-converting–enzyme level is an insensitive and nonspecific diagnostic test and
a poor therapeutic guide.
- For patients without apparent lung involvement, 18FDG PET is useful in identifying sites for diagnostic biopsy.
- 18FDG PET and MRI with gadolinium detect cardiac and neurologic involvement.
- CT imaging is unnecessary for most patients with sarcoidosis. CT is indicated when the chest radiograph is atypical for
sarcoidosis or when hemoptysis occurs.
Clinical Course - Acute : ≤2 years
- Chronic : ≥3–5 years
- Refractory : progressing despite treatment
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