Sarcoidosis is an inflammatory disease in which small clusters of immune cells called granulomas form in organs, most often the lungs and the lymph nodes in the chest. Many patients improve on their own, while some develop lasting lung scarring or involvement of the eyes, skin, heart or nerves.
Key symptoms
- Dry cough and shortness of breath
- Fatigue, fever, weight loss or night sweats
- Red, painful bumps on the shins (erythema nodosum) or other skin lesions
- Eye pain, redness or blurred vision
- Joint pain, often at the ankles
What you find on exam
- Often a normal lung exam; crackles in advanced disease
- Skin lesions: tender shin nodules or purple plaques on the face
- Enlarged lymph nodes in the neck or armpit
- Red eyes; refer for a slit-lamp exam
- Heart rhythm and signs of heart failure
Tests
- Chest X-ray: enlarged lymph nodes at both hila, with or without lung infiltrates
- High-resolution chest CT and pulmonary function tests
- Biopsy showing non-caseating granulomas, often by bronchoscopy with lymph node sampling
- Calcium, kidney and liver tests, ECG and eye exam to screen other organs
Treatment basics
- Watchful follow-up when symptoms are mild and organs work well
- Oral corticosteroids such as prednisone for significant lung, eye, heart or nerve disease
- Steroid-sparing drugs such as methotrexate for long-term or relapsing disease
- Treat high calcium and protect bones during steroid therapy
- Rule out tuberculosis and fungal infection before treatment
Red flags
- Fainting, palpitations or heart block (cardiac sarcoidosis)
- Sudden vision loss or a painful red eye
- Worsening breathlessness or low oxygen
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.