Sarcoidosis

Abstract

More than a century ago, Jonathan Hutchingson, a surgeon-dermatologist, identified the first case of sarcoidosis at King's College, London. The disease is now known as a commonplace multisystem disorder characterized by the formation of noncaseating granulomata. The diagnosis of sarcoidosis is established by recognizing clinicoradiologic findings and providing histologic evidence of non-caseating granuloma. Serum angiotensin converting enzyme levels are high in about two thirds of the patients and hypercalcemia is a feature in one of every ten victims of sarcoidosis. Immunologic abnormalities include depression of cutaneous delayed-type hypersensitivity, accumulation of T-cells at the site of activity, hyperactive B-cells, and the presence of circulating immune complexes. The course and prognosis of the disease usually correlate with the mode of onset. An acute onset with erythema nodosum indicates a good prognosis and spontaneous resolution; whereas, an insidious onset may be followed by relentless, progressive fibrosis. Mortality and morbidity are caused by pulmonary fibrosis, cardiac arrhythmias, renal failure, neurologic involvement, and blindness. Corticosteroids and chloroquine relieve symptoms and suppress inflammation and granuloma formation.

Decrease in Amplitude of Intracardiac Ventricular Electrogram and Inappropriate Therapy in Patients With an Implantable Cardioverter Defibrillator

“…[11][12][13] Cardiac involvement is progressively and potentially fatal, although uncommon. ARVC is characterized by replacement of the myocardium by fatty and fibrous tissue, and myocardial atrophy predominantly in the right ventricle is also progressive.…”

Pulmonary Sarcoidosis

“…Half of patients are asymptomatic and half will complain of nonproductive cough, dyspnea, or chest pain. [1][2][3] Hemoptysis is rare, usually occurs in patients with long-standing disease and cystic degeneration of lung parenchyma, and points to the presence of a complicating infection, especially aspergilloma. 1,4 Pleuropulmonary auscultatory signs are generally absent.…”

“…Approximately 50% of sarcoid patients present in stage 1 and they are often asymptomatic. [1][2][3]5 Despite normal parenchyma on chest radiographs, open lung biopsy in these patients invariably demonstrates granuloma. Approximately half of patients in stage 1 sarcoidosis will also show enlarged paratracheal lymph nodes.…”

“…Approximately 25% of patients present with stage 2 disease. 1,2 In contrast to stage 1, these patients frequently have symptoms of cough or dyspnea, which relate to the radiographic extent of involvement. The parenchymal involvement usually consists of multiple small nodules or reticulonodular infiltrates diffusely throughout both lungs.…”

“…The parenchymal involvement usually consists of multiple small nodules or reticulonodular infiltrates diffusely throughout both lungs. 2 In some patients, the nodules are quite large, sharply circumscribed, and may simulate metastatic tumor. Approximately 50% of patients with stage 2 disease will have spontaneous resolution of the roentgenographic abnormality.…”