93 - Sarcoidosis

Abstract

Sarcoidosis is a multiorgan disease of unknown etiology. The lungs are affected in more than 90% of cases. The diagnosis of sarcoidosis relies on the presence of a compatible clinical presentation and is usually confirmed by the presence of granulomas in biopsy of one or more organs. Alternative causes of granulomatous disease must be eliminated. Lung involvement should be assessed in all suspected cases of sarcoidosis. Chest imaging can demonstrate characteristic patterns; pulmonary function testing can demonstrate restrictive and obstructive patterns. Significant other organ involvement includes the eyes, skin, liver, brain, and heart. Systemic treatment is used in more than half of cases. The indications for treatment are to avoid organ failure and/or to improve patient’s quality of life. Although glucocorticoids remain the usual first systemic drug used, several steroid-sparing agents have been developed. These include antimetabolites such as methotrexate and monoclonal antibodies against tumor necrosis factor such as infliximab. At least one-fourth of patients with sarcoidosis has advanced disease; these patients are at risk for organ failure or death. Among the complications of sarcoidosis leading to death are pulmonary hypertension and pulmonary fibrosis.