Sarcoidosis

Introduction
Sarcoidosis is a multisystem immunological
disorder of unknown etiology that results in lots of
small nodules forming throughout the body.

Noncaseating granulomas (clumps of

inflammatory cells).
Etiology
● It is unknown
● It may be triggered by immune reaction in genetically predisposed
individuals.

Risk factors

Genetic Environment

- African american females - Prior infection with Mycobacterium

- Family members with sarcoidosis tuberculosis & Borrelia burgdorferi
Signs and symptoms

Generalized Specific
symptoms symptoms
Lower respiratory Upper respiratory
● Fever
manifestations sarcoidosis
● Fatigue
Wheezing Laryngeal sarcoidosis: involves
● Weight loss Cough supraglottis.
Dyspnea
● Arthralgia
Chest pain Nasal and sinus sarcoidosis: nasal
Hemoptysis obstruction, nasal crusting, anosmia,
Crackles epistaxis, nasal polyposis.
Clinical Manifestations
Pulmonary involvement

Skin involvement

Ocular involvement Cardiac involvement

Diagnosis
Chest X-ray or CT-Scan

Stage I Stage II Stage III Stage IV

Presence of Bilateral hilar Reticular Reticular

bilateral hilar adenopathy opacities with opacities
adenopathy and reticular shrinking hilar with fibrosis
opacities nodes (mainly
infiltrates)

Blood tests

Bilateral hilar lymphadenopathy

Diagnosis
Biopsy

Bronchoscopy

● Bronchoalveolar lavage → High

levels of T-cells in the lungs.

Histological appearance of
pulmonary sarcoidosis.
Differential diagnosis

Tuberculosis Lung cancer Lymphoma

Lung masses encasing and narrowing bronchial and

vascular systems.
Treatment
It will depend on the severity and can involve supportive treatment and steroids.
Asymptomatic
Requires no treatment, as a majority
of patients undergo spontaneous
remission.
Close monitoring of symptoms, chest
radiograph, and pulmonary function is
continued at three to six-month
intervals should be considered.
Symptomatic
● Oral glucocorticoids
● Steroid-sparing agents: methotrexate,
azathioprine, infliximab, leflunomide in
patients who are unable to tolerate
steroids.
End-stage lung disease: lung transplant. However,
the transplant is also associated with risks and the
need to take immunosuppressive therapy for life.
References
● Bokhari SR, Zulfiqar H, Mansur A. Sarcoidosis [Internet]. StatPearls-NCBI.
National Library of Medicine; 2022 [cited 2023Feb27]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK430687/