Complications
Occurs in people with aspergillomas or bronchiectasis. Bronchial artery embolisation is the only choice for high-risk surgical patients, particularly patients with advanced pulmonary fibrosis.
Alternatively, endobronchial balloon tamponade, preferably through a rigid bronchoscope, may be offered.
Bronchial artery embolisation is less invasive than lung resection, but if embolisation is already performed and bleeding recurs, surgical resection should be contemplated.
Challenging in patients with poor cardiopulmonary reserve.
Sometimes out of proportion to severity of lung disease.
Treatment data are limited, but a favourable response to the short- and long-term use of the vasodilators sildenafil, inhaled prostacyclin analogue iloprost, and bosentan has been observed.[87]
Early ophthalmology referral suggested for suspected ocular involvement.[41]
Patients taking or about to start taking corticosteroids for >6 months are at risk of corticosteroid-induced osteoporosis. It is recommended that all patients taking corticosteroids should be advised to modify their lifestyle factors known to affect bone, such as limiting cigarette smoking and alcohol consumption, increasing weight-bearing activity, and taking steps to prevent falls.
Measures to prevent osteoporosis should be implemented for patients starting corticosteroids. Special care must be taken if vitamin D or calcium is supplemented, because sarcoidosis may cause hypercalciuria and hypercalcaemia by increased endogenous vitamin D. Serum calcium and 24-hour urinary calcium should be monitored before and 1 month after commencing therapy.[74] US guidelines suggest measuring both 25- and 1,25-OH vitamin D levels before vitamin D replacement therapy is started.[31]
Bisphosphonates are beneficial in reducing the risk of vertebral fractures and preventing and treating corticosteroid-induced bone loss at both the lumbar spine and the femoral neck.[90]
Patients treated with immunosuppressive therapy, including corticosteroids for sarcoidosis, may develop invasive fungal infections (e.g., histoplasmosis, blastomycosis, cryptococcosis, or aspergillomas).[91]
A possible complication of methotrexate and azathioprine therapies.
A possible complication of methotrexate and azathioprine therapies.
Occurs later in the disease process where there is cardiovascular involvement.
Including aseptic meningitis. May occur in neurosarcoidosis.
Including endocrinopathy, mass lesions, encephalopathy, and seizures. May occur in neurosarcoidosis.
Including cauda equina syndrome. May occur in neurosarcoidosis.
Including sensorimotor, sensory, motor, mononeuropathy, mononeuropathy multiplex, demyelinating, and Guillain-Barre syndrome. May occur in neurosarcoidosis.
Including myopathy, polymyositis, and atrophy. May occur in neurosarcoidosis.[88]
It may be necessary to differentiate from corticosteroid myopathy.
Early ophthalmology referral suggested for suspected ocular involvement.[41]
Early ophthalmology referral suggested for suspected ocular involvement.[41]
Early ophthalmology referral suggested for suspected ocular involvement.[41]
Early ophthalmology referral suggested for suspected ocular involvement.[89]
Pituitary infiltration is a rare manifestation of sarcoidosis, but most endocrine defects are irreversible despite regression of the granulomatous process.
Patients with chest x-ray stage IV pulmonary sarcoidosis may be particularly prone to infection.
Check local antibiotic susceptibility profile.
A possible complication of calcium and vitamin D supplementation in patients treated with corticosteroids. Special care must be taken if vitamin D or calcium is supplemented, because sarcoidosis may cause hypercalciuria and hypercalcaemia by increased endogenous vitamin D. Serum calcium and 24-hour urinary calcium should be monitored before and 1 month after commencing therapy.[74] US guidelines suggest measuring both 25- and 1,25-OH vitamin D levels before vitamin D replacement therapy is started.[31]
Patients may present with heart block.
Heart block can be high-grade, requiring pacemaker implantation.
Requiring defibrillator placement.
Facial palsy may be a presenting symptom/sign.
When occurs with uveoparotid fever (uveitis/parotitis/facial palsy), prognosis is relatively good.
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