Wednesday, June 10, 2009

Clinical Diagnosis of the month: sarcoidosis!

I just realized I'm falling a bit behind on these suckers. It seems to be more of an "every other month" deal. Ah well.

If you happen to be a big House MD fan, sarcoidosis is not a new term to you. In most episodes, it is either mentioned or a possible evaluation, although I can't recall if any patient has ever actually HAD sarcoidosis. Sarcoidosis is an inflammatory disease that can affect just about anything in your body. In short, your body's immune system goes into overdrive, eventually damaging the tissues where the inflammation occurs. The most notable symptoms are granulomas-small red spots, similar to a rash. These can be found on the organs themselves, or in some cases, on the skin-legs especially. If the granulomas congregate too frequently on an organ, they can inhibit its function. Many cases of sarcoidosis involve lymph nodes and lung tissues, but can also include eyes, skin, liver, kidneys, heart, muscles, and brain (if it's a part of your body, it can be affected).

The cause is unknown, although some scientists believe there are genetic risk factors. General symptoms include: fever, fatigue, weight loss, malaise, and night sweats. If the lungs are the affected tissue, a cough often develops, without dissipating. Shortness of breath and chest pain may also be felt. The lungs are involved in about 90% of cases. If the lymph nodes are affected, swelling is seen. Anybody noticing a lousy trend here?

Sarcoidosis sounds a lot like most diseases. The symptoms are nonspecific, and sound a lot like many common ailments. Diagnosis is extremely difficult. Various tests can be used, but it often takes a while for the proper diagnosis. Physical exams, blood tests, chest x-rays, pulmonary function tests, fiberoptic bronchoscopy, CT scans, MRI's, and PET's are some of the more common methods employed to elucidate a diagnosis.

In some cases, no treatment is offered-it's expected that the disease with wax and wan over time. If the symptoms are bad enough, corticosteroids (prednisone, cortisone, prednisolone), anti-malaria meds (hydroxychloroquine), or immunosuppressants (methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine) may be administered.

For more information, check out Stop Sarcoidosis, or the National Heart Lung and Blood Institute.


  1. Are the sarcoidosis inflammatory lesions histologically apparent in a tissue biopsy?

  2. In certain tissues, yes. Most commonly, granulomas can be visualized with the assistance of various scans (MRI's), as well as with biopsies. Lung lesions are frequent, and relatively easy to identify. Unfortunately, lung biopsies (well, biopsies in general) are not exactly fun.