Elsevier

Clinics in Chest Medicine

Volume 25, Issue 3, September 2004, Pages 521-530
Clinics in Chest Medicine

Pulmonary sarcoidosis

https://doi.org/10.1016/j.ccm.2004.04.006Get rights and content

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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.

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