Sarcoidosis is a disease in which

inflammation occurs in the lymph nodes,

lungs, liver, eyes, skin, or other tissues.
It is due to hypersensitivity of predisposed
person to bacteria, fungi, virus and
chemicals.
Many patients with sarcoidosis have no
symptoms. The granulomas, hidden within
the body's organs, are discovered only if
carefully looked for.
Although these granulomas are usually
widespread, they are very small and can only
be seen with the aid of the microscope.



Sarcoidosis occurs in all ages and races and
in both sexes. It does not favor any socio-
economic status, occupation, or level of
education, and it is not caused by cigarette
smoking, alcohol, or drugs. But some
manifestation are more common in women.In
the United States sarcoidosis seems to be
most common among african american, but
the reason is entirely unknown.

In Stage I the lymph nodes of the lungs near the center
of the chest (the hilar areas) become enlarged,
sometimes to the size of potatoes. The lungs
themselves don't show any disease on the chest xray.
Stage I patients usually have no symptoms and require
no treatment (Figure 1a).
In Stage II there are enlarged lymph nodes, and in
addition an abnormal pattern in the lung fields (Figure
1b). Stage II patients usually show some decrease in
pulmonary function, as well as symptoms (cough or
dyspnea); they may require treatment.
Stage III shows the lung infiltrates without evidence of
enlarged lymph nodes in the hilar areas (Figure 1c). It is
possible these patients once had the hilar "potato
nodes," and that progression of their disease lead to
lung involvement with disappearance of the nodes. For
most patients who present with Stage III, however, this
progression cannot be demonstrated.

The cause of the disease is unknown. In
sarcoidosis, tiny clumps of abnormal tissue
(granulomas) form in certain organs of the body.
The disease can affect almost any organ of the
body, but it most commonly affects the lungs.
Possible causes of sarcoidosis include:
Extreme immune response to infection
High sensitivity to environmental factors
Genetic factors
The disease typically begins between ages 20 and
40. Sarcoidosis is very rare in young children.
A person with a close blood relative who has
sarcoidosis is nearly five times as likely to
develop the condition.

Many people with sarcoidosis are not
seriously ill, and the disease may get better
without treatment. About 30 - 50% of cases
get better without treatment in 3 years.
About 20% of people whose lungs are
involved will develop lung damage.
The overall death rate from sarcoidosis is
less than 5%. Causes of death include:
Bleeding from the lung tissue
Heart damage, leading to heart failure and abnormal
heart rhythms
Lung scarring (pulmonary fibrosis)

The outlook for
sarcoidosis varies. Many
people recover from the
disease with few or no
long-term problems.
More than half of the
people who have
sarcoidosis have remission
within 3 years of
diagnosis.
There may be no symptoms. When symptoms occur,
they can involve almost any body part or organ
system in your body.
Almost all patients have lung or chest symptoms:
Chest pain (most often behind your breast bone)
Dry cough
Shortness of breath
Symptoms of general discomfort or uneasiness often
occur:
Fatigue(one of the most common symptoms in
children)
Fever
Joint achiness or pain (arthralgia)
Overall feeling of discomfort, illness, or lack of well-
being
Weight loss (one of the most common symptoms in
children)

Skin symptoms:
Hair loss
erythema nodosum
Lupus perrio
Scars that become raised or
inflamed
Nervous system symptoms may
include:
Headache
Weakness on one side of the
face
Eye symptoms include:
Burning
Dry eyes
Itching
Pain
Vision loss
Other symptoms of this disease:
Dry mouth
Nosebleed

Chest X-ray are used to assess pulmonary
adenopathy, this may show hilar adenopathy
and disseminated miliary and nodular lesions
in the lungs.
The client has to have chest x-ray every 6
months to monitor progression of the disease
A mediastinoscopy or transbronchial biopsy
(in which a tissue specimen is obtained
through the bronchial wall)used to confirm
the diagnosis.
Diagnosis isconfirmed by a biopsy that show
non caseasting granulomas.
In rare cases, open an open lung biopsy is
perormed.
Sarcoidosis symptoms will often get
better on their own slowly without
treatment.
Patients whose eyes, heart, nervous
system, or lungs are involved may
need to be treated with corticosteroids
because of their anti-infalammatory
effects.

Hydroxychloroquine is useful for skin
sarcoidosis.
The other tool is a blood test called
"Angiotensin Converting Enzyme" or ACE. For
unknown reasons the ACE level is elevated in
most active sarcoidosis cases. In fact an
elevated ACE level and characteristic gallium
scan, along with a compatible clinical history
and chest xray picture, are often diagnostic
of sarcoidosis even without a tissue biopsy.

Fungal lung infections (aspergilloma)
Glaucoma and blindness from uveitis
(rare)
Kidney stones from high calcium
levels in blood or urine
Osteoporosis and other complications
of taking corticosteroids for long
periods of time.
Pulmonary hypertension