Sarcoidosis is a multi-system granulomatous disorder of unknown cause.

It is asymptomatic in up to 40% of cases, being discovered incidentally on a routine CXR.

Features of sarcoidosis may be divided into pulmonary and non-pulmonary:

Pulmonary features of sarcoidosis:
  • dry cough
  • progressive dyspnoea
  • chest pain
  • wheeze
Non-pulmonary features of sarcoidosis include:
  • Lymphadenopathy
  • Skin involvement (25%). Includes erythema nodosum (affects 1 in 10) and lupus pernio (which affects more females)
  • Liver involvement
  • Occular involvement – anterior uveitis, glaucoma, cataract
  • Polyarthralgia
  • Neurosarcoid – including Bells palsy
  • Hypercalcaemia (10%). Due to dysregulated production of calcitriol by activated macrophages and granuloma
  • Cardiac involvement
  • Renal stones

90% of patients with sarcoid will have an abnormal CXR.
Staging of CXR in sarcoid is:
  • 0 = clear CXR
  • 1 = bilateral hilar lymphadenopathy (BHL)
  • 2 = bilateral hilar lymphadenopathy plus pulmonary infiltration
  • 3 = pulmonary infiltration only
  • 4 = fibrosis, honeycombing, pleural involvement
Note staging is purely radiological and does not correlate with pulmonary function

  • CXR
  • HRCT
  • Bloods
    • Raised serum ACE (50%)
    • Raised calcium (10%)
    • LFTs - looking for liver involvement
    • Possibly lymphopenia
  • Urinary calcium 
  • Biopsy - TBLB (transbronchial lung biopsy) and endobronchial
  • Lung function tests
  • ECG - ?cardiac involvement

  • BHL alone doesn't need treatment, neither does stage II or III disease if lung function tests are only mildly abnormal
  • acute sarcoidosis : NSAIDs and bed rest
  • prednisolone ( 0.5/mg/kg for 4 weeks then reducing dose to control symptoms for 12-24 months) is indicated if:
    • symptomatic pulmonary disease or progressive loss of lung function
    • cardiac disease
    • neurological disease
    • eye disease
    • symptomatic hypercalcaemia
Methotrexate decreases requirement for steroid.
Bisphosphonates should be given to protect bone.

In end

Prognosis: 2/3 remit within a decade, 1/3 progressive

Last reviewed: Jan 2015

Small print gem: Löfgren's syndrome is a form of sarcoidosis consisting of arthritis, erythema nodosum, and bilateral hilar lymphadenopathy. Females more affected than males. Good prognosis – most cases resolve.

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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)