Abstract
Sarcoidosis is a non-necrotizing granulomatous inflammatory syndrome with multisystemic manifestations. We performed a systematic review of sarcoidosis in the pediatric population with particular emphases on early onset sarcoidosis, high-risk sarcoidosis, and newly reported or unusual sarcoid-related diseases. Blau Syndrome and early onset sarcoidosis/ BS-EOS are seen in children younger than five years old presenting with extra-thoracic manifestations but usually without lymphadenopathy and/or pulmonary involvement. The prevalence of high-risk sarcoidosis is very low in children and is further limited by the difficulty of diagnosis in symptomatic children and underdiagnosis in subclinical or asymptomatic patients. Reports of sarcoidal syndromes in users of E-cigarette/marijuana/other flavorings and their induction in cancer immunotherapies are of interests and may be challenging to differentiate from metastatic malignancy. The diagnostic considerations in pediatric sarcoidosis are to support a compatible clinicoradiographic presentation and the pathologic findings of non-necrotizing granulomas by ruling out granulomas of infective etiology. There is no absolutely reliable diagnostic test for sarcoidosis at present. The use of endoscopic bronchial ultrasound (EBUS) and transbronchial fine needle aspiration (TBNA) sampling of intrathoracic lymph nodes and lung, and for superficially accessible lesions, with cytopathological assessment and pathological confirmations provide fair diagnostic yield and excellent patient safety profile in children.
Highlights
Sarcoidosis is a multisystemic syndrome with a highly variable clinical course and diverse disease manifestations [1]
The true incidence and prevalence of sarcoidosis in children is unknown as the disease is much less common in children than in adults [13]
It is difficult to diagnose in symptomatic children and may remain undiagnosed in subclinical or asymptomatic patients [8,11]
Summary
Sarcoidosis is a multisystemic syndrome with a highly variable clinical course and diverse disease manifestations [1]. The clinical phenotypes range from single-organ, self-limited, asymptomatic disease to multi-organ involvement with high-risk manifestations [9]. Sarcoidosis Workshop 2017 [1] to denote several manifestations of sarcoidosis that are associated with impaired quality of life and relatively high risk of death [9]. These include treatment-resistant pulmonary sarcoidosis, cardiac sarcoidosis, neurosarcoidosis, and/or multi-organ involvement. The high-risk manifestations and multi-organ involvements are often missed until late in the disease course [9]. The diagnosis of sarcoidosis is relatively uncommon in children [8,11,12,13], and high-risk sarcoid may present differently in children than in adults [8,14]. We search the English literature and aim to review the clinical investigations and laboratory diagnostics of sarcoidosis in this population
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