Pulmonary sarcoidosis
Section snippets
Clinical presentation
Patients with sarcoidosis may have no symptoms at all and only are diagnosed by chest radiograph obtained for nonpulmonary reasons. Conversely, they can present with severe respiratory symptoms and even can die from this [2]. This wide range may lead to some delay in the diagnosis of sarcoidosis.
In the United States, a case-controlled etiologic study of sarcoidosis (ACCESS) recently was completed [3]. The study examined 736 patients with sarcoidosis within 6 months of their diagnosis. All cases
Diagnosis
The diagnosis of sarcoidosis is based on the finding of a granuloma in a patient with a compatible clinical history and no other cause of granulomas identified [14]. Although pathologic tissue is a major part of the diagnosis, it is neither necessary nor sufficient for the diagnosis. There are several other causes of granulomas, including infections such as tuberculosis and fungal infections. Beryllium and other metals also have been found to cause granulomatous reactions [14]. Granulomas have
Treatment
Therapy of sarcoidosis usually is based on symptoms [14]. There are a few absolute indications for therapy, including cardiac and neurologic involvement, hypercalcemia, and ocular disease that has not responded to topical therapy [17], [44].
Pulmonary disease is a relative indication for therapy. Asymptomatic patients with parenchymal lung disease (stage 2 or 3) may not benefit from systemic therapy. In a study of 149 patients who presented with pulmonary sarcoidosis, 58 (39%) had spontaneous
Summary
Sarcoidosis is a common pulmonary interstitial lung disease. Extrathoracic involvement may support the diagnosis. A final diagnosis is usually made based on the finding of granulomas in patients with a compatible clinical history. The treatment of sarcoidosis ranges from none to complex immunosuppressive agents. Given the range of effective therapies for sarcoidosis, it is important to make the diagnosis and prescribe treatment appropriately.
References (90)
- et al.
Course and prognosis of sarcoidosis in a nonreferral setting: analysis of 86 patients observed for 10 years
Am J Med
(1985) - et al.
Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis
Chest
(2001) - et al.
Sarcoidosis
Lancet
(2003) - et al.
The diagnostic pathway to sarcoidosis
Chest
(2003) - et al.
The clinical application and cost analysis of fine-needle aspiration biopsy in the diagnosis of mass lesions in sarcoidosis
Chest
(2000) - et al.
The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis
Chest
(2003) - et al.
Diagnosing sarcoidosis using endosonography-guided fine-needle aspiration
Chest
(2000) - et al.
Role of bronchoalveolar lavage in interstitial lung disease
Clin Chest Med
(2001) Sarcoidosis: usual and unusual manifestations
Chest
(1988)- et al.
Bronchoalveolar lavage fluid profiles in sarcoidosis, tuberculosis, and non-Hodgkin's and Hodgkin's disease: an evaluation of differences
Chest
(1994)
Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis
Chest
Computer program supporting the diagnostic accuracy of cellular BALF analysis: a new release
Respir Med
Endobronchial biopsy for sarcoidosis: a prospective study
Chest
Bronchoscopy with bronchoalveolar lavage in tuberculosis and fungal infections
Chest
Outcome in sarcoidosis: the relationship of relapse to corticosteroid therapy
Chest
Low-dose methotrexate therapy for childhood sarcoidosis
J Pediatr
Methotrexate for sarcoid-associated panuveitis
Ophthalmology
Treatment of cutaneous and pulmonary sarcoidosis with thalidomide
J Am Acad Dermatol
Thalidomide for chronic sarcoidosis
Chest
54-week results on infliximab attract attention at EULAR: European League against Rheumatism
Lancet
Response of cutaneous Crohn's disease to infliximab and methotrexate
Dig Liver Dis
Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis
Chest
Clinical characteristics of patients in a case control study of sarcoidosis
Am J Respir Crit Care Med
Predicting respiratory failure in sarcoidosis patients
Sarcoidosis
Design of a case controlled etiologic study of sarcoidosis (ACCESS)
J Clin Epidemiol
The ACCESS study: characterization of sarcoidosis in the United States
Am J Respir Crit Care Med
Clinical findings in 715 patients with newly detected pulmonary sarcoidosis: results of a cooperative study in former West Germany and Switzerland. WATL Study Group: Wissenschaftliche Arbeitsgemeinschaft für die Therapie von Lungenkrankheiten
Sarcoidosis Vasc Diffuse Lung Dis
The mode of presentation of sarcoidosis in Finland and Hokkaido, Japan: a comparative analysis of 571 Finnish and 686 Japanese patients
Sarcoidosis
A clinical, radiographic, and physiologic scoring system for the longitudinal assessment of patients with idiopathic pulmonary fibrosis
Am Rev Respir Dis
Use of fluticasone in acute symptomatic pulmonary sarcoidosis
Sarcoidosis Vasc Diffuse Lung Dis
Is there an anatomic explanation for chest pain in patients with pulmonary sarcoidosis?
South Med J
Prognosis of intrathoracic sarcoidosis in England
BMJ
Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment
Radiology
ATS/ERS/WASOG statement on sarcoidosis: American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders
Sarcoidosis Vasc Diffuse Lung Dis
Breast disease in sarcoidosis
Sarcoidosis Vasc Diffuse Lung Dis
Hodgkin's disease with a granulomatous pulmonary presentation mimicking sarcoidosis
Thorax
Sarcoidosis presenting in patients older than 50 years
Sarcoidosis Vasc Diffuse Lung Dis
Sarcoidosis: epidemiology and prognosis. A 15-year European study
Am Rev Respir Dis
Bronchoscopic diagnosis of sarcoidosis
Eur Respir J
Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis
Ann Otol Rhinol Laryngol
The value of bronchoalveolar lavage in the diagnosis and prognosis of sarcoidosis
Eur Respir J
The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis
Eur Respir J
Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity
N Engl J Med
Prognostic value of bronchoalveolar lavage in sarcoidosis: the critical influence of disease presentation
Thorax
Alveolar T-cell subsets in pulmonary sarcoidosis: correlation with disease activity and effect of steroid treatment
Am Rev Respir Dis
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Th17-lineage cells in pulmonary sarcoidosis and Löfgren's syndrome: Friend or foe?
2018, Journal of AutoimmunitySarcoidosis
2015, Dermatologic ClinicsCitation Excerpt :At some point, 90% of patients have abnormal chest radiographs (Table 4). About two-thirds of cases develop restrictive disease and 30% to 50% also have obstructive changes, but in 80% spirometric findings return to normal within 2 years.103–105 Pulmonary hypertension is a serious complication that occurs in 1% to 6% of patients overall, usually in symptomatic cases of pulmonary disease.106
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