The Clinical Features of Sarcoidosis: A Comprehensive Review

Abstract

Sarcoidosis has innumerable clinical manifestations, as the disease may affect every body organ. Furthermore, the severity of sarcoidosis involvement may range from an asymptomatic state to a life-threatening condition. This manuscript reviews a wide variety of common and less common clinical characteristics of sarcoidosis. These manifestations are presented organ by organ, although additional sections describe systemic and multiorgan presentations of sarcoidosis. The lung is the organ most commonly involved with sarcoidosis with at least 90 % of sarcoidosis patients demonstrating lung involvement in most series. The skin, eye, liver, and peripheral lymph node are the next most commonly clinically involved organs in most series, with the frequency of involvement ranging from 10 to 30 %. The actual frequency of sarcoidosis organ involvement is probably much higher as it is frequently asymptomatic and may avoid detection. This is particularly common with lung, liver, cardiac, and bone involvement. Cardiac sarcoidosis is present in 25 % of all sarcoidosis but only causes clinical problems in 5 % of them. Nevertheless, unlike sarcoidosis involvement of most other organs, it may be suddenly fatal. Therefore, it is important to screen for cardiac sarcoidosis in all sarcoidosis patients. All sarcoidosis patients should also be screened for eye involvement as asymptomatic patients may have eye involvement that may cause permanent vision impairment. Pulmonary fibrosis from sarcoidosis is usually slowly progressive but may be life-threatening because of the development of respiratory failure, pulmonary hypertension, or hemoptysis related to a mycetoma or bronchiectasis. Some manifestations of sarcoidosis are not organ-specific and probably are the result of a release of mediators from the sarcoid granuloma. Two such manifestations include small fiber neuropathy and fatigue syndromes, and they are observed in a large percentage of patients.

Increased pulse wave velocity in pulmonary sarcoidosis: a preliminary study

“…1 On the basis of the modified Matzinger's model of immune response and the results of our studies as well as those of other investigators, human heat shock proteins (HSPs) as main "danger signals" or microbial HSPs as pathogen-associated molecular patterns recognized by pattern recognition receptors on altered APCs may induce inflammation in sarcoidosis by both noninfectious and infectious factors in a genetically differently predisposed host. 2 The disease typically affects the lungs and mediastinal lymph nodes, but it may also occur in other organs such as the liver, eyes, skin, and heart.…”

Physical activity and training in sarcoidosis: review and experience-based recommendations

“…Moreover, patient involvement can influence the priorities of clinical care. In the management of sarcoidosis, therapeutic approaches should include strategies to restore QoL, with special emphasis on energy and fatigue [9,38]. In terms of the impact on patients' lives, lack of energy, physical impairment, and fatigue are the most important QoL domains affecting them.…”

“…It may occur at all ages and presents with lung involvement in the majority of cases [7][8][9][10][11]. Extrapulmonary manifestations of this disease involve the heart, joints, kidney, liver, eyes, nervous system, and skin.…”

The Diagnosis of Sarcoidosis

“…7 Despite the seeming multitude of possible presentations of sarcoidosis, several are typical whereas others are less common to rare. 8 Knowledge a priori of the commonest organs involved in sarcoidosis and their associated symptoms is useful when considering a diagnosis of sarcoidosis. Table 1 shows the observed frequency of organ involvement within 6 months of diagnosis in the 736 patients enrolled in the AC-CESS study 9 and Table 2 shows the commonest presenting symptoms of the various organ systems.…”