Sarcoidosis

Boeck's Sarcoid, Boeck's Disease

What is Sarcoidosis?

Sarcoidosis is characterized by collections of chronic inflammatory cells (lymphocytes), typically in the chest, eye, or skin. Half of the individuals have no symptoms, and the disease is discovered accidentally. Its cause is unknown, but it may be an autoimmune disorder. The disease usually subsides spontaneously, but it can also last for years with relapsing episodes.

Sarcoidosis occurs mainly between the ages of 20 and 40. In the US, the disease seems to be more prevalent in the southeast and in individuals born in the southeast. It is most common in black women.

How is it diagnosed?

History is variable. When symptoms are present, they commonly include a dry cough, shortness of breath, pain in the eye or visual disturbances, and painful joints. There can be generalized symptoms of fatigue, fever, aching muscles, or loss of appetite.

Physical exam may note enlarged lymph nodes, an enlarged liver and spleen, and a reddish raised rash. Eye involvement is common and the eyes may exhibit redness, pain, decreased vision and inflammatory cells and nodules within the eye.

Tests: Chest x-ray will commonly show enlarged lymph nodes and/or infiltrates of the lungs. If a biopsy is done, microscopic examination may show the accumulation of lymphocytes. Blood tests will show elevated calcium and elevated liver enzymes. Blood tests may show elevated angiotensin -1 converting enzyme, which can, occasionally, be used to assess disease progression/regression. Pulmonary function tests may be used to detect response to therapy and loss of respiratory function. If heart involvement is present (five-percent), an electrocardiogram may be done to measure conductance disturbances.

How is Sarcoidosis treated?

Corticosteroid drugs are prescribed to reduce inflammation and relieve symptoms. When the lungs are involved such treatment may be continued for a year or longer. Topical medication may be used for treatment of skin lesions. If the accumulation of inflammatory cells blocks vessels or results in fibrotic damage to important tissues upon healing, surgery may be needed.

Medications

Information Brand Generic Label Rating
Prednisone Deltasone Prednisone
Imuran Azathioprine
Rheumatrex Methotrexate

What might complicate it?

Complications of sarcoidosis depend upon the organ affected, the extent of disease, and the time to resolution. If the lesions occur in blood vessels or ducts, blockage can affect organ function. Lesions in the muscles, heart, lungs, liver, spleen, central nervous system or eyes may be expected to result in more complications than lesions of the skin or lymph nodes.

Predicted outcome

The predicted outcome for sarcoidosis is variable. Generally the prognosis is excellent. When vital organs are affected for long periods of time, the outcome may be poorer.

Alternatives

Other diseases that may produce lesions or symptoms similar to those of sarcoidosis are tuberculosis, fungal infections, chronic inhalation of coal dust or silica, exposure to beryllium, or lymphoma.

Appropriate specialists

Pulmonary specialist, internist, dermatologist, cardiologist, and ophthalmologist.

Last updated 6 October 2011


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