Sarcoidosis: Symptoms, Diagnosis, and Treatment Options

Chest pain associated with sarcoma?

Hello Doctor: Last October, I experienced prolonged unexplained fever (38 degrees Celsius) and visited the infectious disease department multiple times for examinations.
During this period, I also had night sweats, weight loss (3 kg in one month), shortness of breath, and chest tightness.
Blood tests, urine tests, stool tests, and X-rays all came back normal.
Eventually, the doctor suggested hospitalization for further testing, including viral tests and other blood tests, which also returned normal results.
After a full-body scan, enlarged lymph nodes were found in the thoracic and abdominal cavities.
Following a CT scan, the doctor recommended a biopsy.
After ruling out tuberculosis, I was informed that it was likely sarcoidosis, and I was referred to the rheumatology and immunology department for treatment.
This was already early December.
The immunologist initially prescribed one immunosuppressive medication and one steroid daily, later increasing the steroid dosage to three tablets per day, but my symptoms did not improve.
After another X-ray (which was normal two months ago), it was found that both sides of my lungs appeared white, and the doctor mentioned signs of lymph node infiltration.
During this follow-up, I was prescribed two immunosuppressive tablets (morning and evening) and six steroids (two each in the morning, afternoon, and evening), but the discomfort in my chest did not alleviate; in fact, it felt worse.
Recently, I often feel a burning pain in my chest when breathing, and I have persistent chest tightness, but I do not cough.
There is a burning sensation in my bronchial area, occasionally accompanied by pain, and sometimes the burning sensation radiates to my back.
I feel my heart racing and pounding, as if it might burst out, but when I check my pulse, it is normal.
Occasionally, I experience localized abdominal pain, but there are no abnormalities upon palpation.
Watching emotional TV dramas makes me feel like I can't breathe and need to gasp for air for a long time.
I am currently very uncomfortable and avoid watching anything that makes me cry.
My body temperature often remains between 37.4-37.5 degrees Celsius.
Since my next appointment is still over a week away, I would like to ask the doctor if it is necessary to schedule an earlier visit or if I should see another specialist.
Are there any methods to alleviate my symptoms? This condition seems quite rare, and it is difficult to find information about it, which is very frustrating.
Additionally, since the hospital I am currently visiting is far away, if I want to switch to another healthcare provider, what medical records should I bring to help the new doctor quickly understand my situation?

Elsa, 20~29 year old female. Ask Date: 2017/01/07

Dr. Zeng Guosen reply Internal Medicine

1.
Sarcomatoid carcinoma is not a common disease, and it is recommended to seek medical attention at a medical center.
2.
Bringing all relevant medical records can help the physician quickly understand your condition.
Thank you for your inquiry.

Reply Date: 2017/01/07

More Info

Sarcoidosis is a complex and often misunderstood condition that can present with a variety of symptoms and affect multiple organ systems. It is characterized by the formation of non-caseating granulomas, which are small clusters of inflammatory cells. The exact cause of sarcoidosis remains unknown, but it is believed to involve an abnormal immune response, possibly triggered by environmental factors or infections.

Symptoms of Sarcoidosis
The symptoms of sarcoidosis can vary widely depending on which organs are affected. Common symptoms include:
- Fatigue: Many patients report persistent fatigue, which can significantly impact daily life.

- Weight Loss: Unexplained weight loss is another common symptom, often accompanying fatigue.

- Fever and Night Sweats: Low-grade fevers and night sweats can occur, as you have experienced.

- Respiratory Issues: Shortness of breath, chest pain, and a persistent cough may develop if the lungs are involved.

- Skin Manifestations: Some patients may develop skin lesions or rashes.

- Eye Problems: Sarcoidosis can lead to eye inflammation, causing redness, pain, or vision changes.

- Heart Symptoms: In some cases, sarcoidosis can affect the heart, leading to palpitations or arrhythmias.

Diagnosis
Diagnosing sarcoidosis can be challenging due to its nonspecific symptoms and the need to rule out other conditions, such as infections (like tuberculosis) or malignancies. The diagnostic process typically involves:
1. Medical History and Physical Examination: A thorough review of symptoms and a physical exam to assess for signs of organ involvement.

2. Imaging Studies: Chest X-rays and CT scans are commonly used to identify lymph node enlargement or lung involvement.

3. Biopsy: A definitive diagnosis often requires a biopsy of affected tissue (e.g., lymph nodes, lung tissue) to identify non-caseating granulomas.

4. Blood Tests: Tests may include measuring levels of angiotensin-converting enzyme (ACE), which can be elevated in sarcoidosis.

Treatment Options
Treatment for sarcoidosis depends on the severity of the disease and the organs involved. Many patients experience spontaneous remission, especially those with mild symptoms. However, for those with more severe manifestations or significant organ involvement, treatment may be necessary:
- Corticosteroids: Prednisone is the most commonly prescribed medication to reduce inflammation and suppress the immune response. The dosage may vary based on symptom severity and response to treatment.

- Immunosuppressive Agents: If corticosteroids are ineffective or cause significant side effects, other immunosuppressive medications (such as methotrexate or azathioprine) may be considered.

- Symptomatic Treatment: Additional treatments may be needed to manage specific symptoms, such as bronchodilators for respiratory issues or pain management strategies.

When to Seek Further Medical Attention
Given your ongoing symptoms, including chest discomfort, rapid heart rate, and persistent feelings of breathlessness, it is advisable to consult your healthcare provider sooner rather than later. These symptoms could indicate worsening of your condition or complications that may require immediate attention.

Preparing for a New Consultation
If you decide to seek care from a different healthcare provider, it is essential to bring relevant medical records to facilitate a comprehensive evaluation. Key documents to include are:
- Previous Medical Records: Any records from your past consultations, including notes from specialists.

- Imaging Reports: Copies of X-rays, CT scans, or MRIs that have been performed.

- Laboratory Results: Blood tests, biopsies, and any other relevant lab work.

- Medication List: A list of all medications you are currently taking, including dosages and duration.

In summary, sarcoidosis is a multifaceted disease that requires careful management and monitoring. Your symptoms warrant further evaluation, and being well-prepared for your next appointment will help ensure you receive the best possible care.

Similar Q&A

Understanding Sarcoidosis: Symptoms, Diagnosis, and Treatment Options

I have been experiencing fatigue, weight loss, low-grade fever, and night sweats for the past few months, but I have not had a cough or cold. After an examination, my doctor said that both my white blood cells and red blood cells are normal and suggested monitoring my condition. ...

Dr. Zhao Chongliang reply Internal Medicine
Sarcoidosis is quite rare in Taiwan, with occasional reports from Japan, primarily affecting African Americans and Scandinavians. It is an idiopathic, non-caseating granulomatous disorder that can involve multiple organ systems, previously thought to be related to birch pollen al...

Understanding Sarcomatoid Carcinoma: Diagnosis, Treatment, and Prognosis

How is the diagnosis and treatment of sarcomatoid carcinoma established? Is it curable?

Dr. Lin Sixie reply Rare Disease
Sarcoidosis is a chronic, idiopathic disease characterized by noncaseating granulomas that can affect multiple organ systems. It primarily occurs in young adults, with a peak incidence between the ages of 20 and 40, and has a similar prevalence in both males and females. The dise...

Understanding Sarcoidosis: Insights from Dermatology Experts

Hello Dr. Liao Wenyu: The English term for the diagnosis of sarcoidosis is "sarcoid."

Dr. Liao Wenyu reply Dermatology
The correct name for Sarcoid is Sarcoidosis. Therefore, I am not sure if what you refer to as Sarcoid is indeed this condition. Sarcoidosis is a relatively rare disease, typically diagnosed through pathological biopsy. The cause is unknown, but clinically, your symptoms do not re...

Understanding Pseudolymphoma: Causes, Symptoms, Treatment, and Prognosis

Within a year, multiple old scar tissues on the body have noticeably enlarged, and there are several areas of scarring without any recollection of previous injuries. A biopsy was performed, revealing a fungal infection in one scar (which had no external injury and was from over t...

Dr. Liao Wenyu reply Dermatology
The English diagnosis for "類肉瘤" is "sarcoid" or "sarcoidosis." However, if you are referring to a specific skin condition, it may be more appropriate to use "granuloma" or "granulomatous dermatitis," depending on the context.