Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis

Abstract

Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25–50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren’s syndrome, lupus pernio, Heerfordt’s syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.

Challenging Mimickers in the Diagnosis of Sarcoidosis: A Case Study

“…Most of the time, atypical features at diagnosis may help the clinician to distinguish sarcoidosis from its mimickers. Some clinical features are very atypical in a presumed sarcoidosis such as an unusual age at onset (before 25 and after 45 years old except for women for whom a second peak of incidence is noted after 50 years old), impaired general conditions, high fever (can be seen in Löfgren’s syndrome, Heerfordt’s syndrome, hepatic or renal sarcoidosis) clubbing, crackles at auscultation, hemoptysis or acute or subacute dyspnea (especially in the absence of lung fibrosis) [ 210 ]. Other organ involvements can be atypical too.…”

Awareness of pulmonary sarcoidosis in the older adult: A case study approach

“…The nurse tells Mrs. Brown that other organs can be affected by sarcoidosis and there are symptoms associated with each. The following organs and systems may be impacted by sarcoidosis: skin, lymph node involvement, eye, musculoskeletal system, vestibular system, neurological system, heart, liver, renal system, and the brain [8]. Knowing the basic symptoms that are associated with each impacted organ and system is essential for Mrs. Brown to know as she monitors her sarcoidosis over time.…”

Classification of Non-Infectious and/or Immune Mediated Choroiditis: A Brief Overview of the Essentials

“…Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology [ 132 ]. Lung involvement occurs most frequently, and skin and eye lesions are next in frequency.…”