Sarcoidosis

Sarcoidosis is a diagnosis of exclusion of granulomatous lung diseases, including tuberculosis and histoplasmosis.

Typical history is essential to establish the diagnosis, and biopsy from affected organs is often required.

Treated with topical corticosteroids for mild local cutaneous disease. Systemic corticosteroids are the mainstay of treatment for severe disease. Immunomodulatory therapies are corticosteroid-sparing and can be used in the treatment of corticosteroid-refractory disease.

Poorer prognosis if black ancestry, chronic pulmonary involvement, lupus pernio, or chronic hypercalcaemia.

Spontaneous remissions occur in 55% to 90% of patients with stage I, 40% to 70% of patients with stage II, and about 20% of patients with stage III disease. Remission is not expected in patients with stage IV disease.

Sarcoidosis is a chronic granulomatous disorder of unknown aetiology, commonly affecting the lungs, skin, and eyes. It is characterised by accumulation of lymphocytes and macrophages and the formation of non-caseating granulomas in the lungs and other organs. Although lungs and lymph nodes are involved in more than 90% of patients, virtually any organ can be involved.[1]Belperio JA, Shaikh F, Abtin FG, et al. Diagnosis and treatment of pulmonary sarcoidosis: a review. JAMA. 2022 Mar 1;327(9):856-67. http://www.ncbi.nlm.nih.gov/pubmed/35230389?tool=bestpractice.com ​ The clinical course is often heterogeneous and unpredictable.