Sarcoidosis: Symptoms, Diagnosis, and Treatment Options

Sarcoidosis is a systemic granulomatous disease

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.
However, I recently experienced palpitations, and after further evaluation, the cardiologist found no issues and referred me to a pulmonologist.
The pulmonologist suspects a condition like sarcoidosis.
I would like to ask about what sarcoidosis is and what the treatment options are.

wen, 10~19 year old female. Ask Date: 2005/05/04

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 allergy, but this has been refuted.
It most commonly occurs in young adults aged 20 to 40 years and can affect peripheral lymph nodes, liver, spleen, kidneys, eyes, central nervous system, heart, and skeletal system.
However, it typically presents with bilateral hilar lymphadenopathy and pulmonary infiltrative lesions, which can be detected with a simple chest X-ray.
Further evaluation may include gallium-67 scintigraphy (with sensitivities of 70% for lung parenchyma, 95% for hilar lymph nodes, and an overall sensitivity of up to 90%) and measurement of serum angiotensin-converting enzyme (ACE) levels (which may rise in about 50% to 80% of active cases and correlates with disease activity).
Positron emission tomography (PET) is also being explored, as both pulmonary lymphadenopathy and extra-pulmonary lesions can uptake 2-deoxy-2-[18F]fluoroglucose (FDG).
Approximately 50% of patients are asymptomatic, and about 65% have self-limiting disease.
Although 20-30% of patients may experience permanent pulmonary dysfunction, only about 5% of cases result in death due to progressive pulmonary fibrosis and cor pulmonale.
I am unsure why your physician suspects this rare disease; in Taiwan, given your age, tuberculosis should be considered first, and if not, certain lymphatic disorders should be evaluated.

Reply Date: 2005/05/04

More Info

Sarcoidosis is a complex and often misunderstood condition that primarily affects the lungs but can involve 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, potentially triggered by environmental factors, infections, or genetic predispositions.

Symptoms
The symptoms of sarcoidosis can vary widely depending on the organs involved. Common symptoms include:
1. Fatigue: Many patients report persistent fatigue, which can significantly impact daily activities.

2. Weight Loss: Unintentional weight loss is often noted, as you mentioned in your case.

3. Fever and Night Sweats: Low-grade fevers and night sweats are common, contributing to discomfort and sleep disturbances.

4. Respiratory Symptoms: While you noted the absence of cough or cold symptoms, respiratory issues such as dry cough, shortness of breath, and chest pain can occur in many patients.

5. Skin Lesions: Some individuals may develop skin rashes or lesions, such as erythema nodosum.

6. Eye Problems: Sarcoidosis can affect the eyes, leading to symptoms like blurred vision or eye pain.

7. Heart Issues: Although less common, sarcoidosis can affect the heart, leading to arrhythmias or heart failure, which may explain your episodes of palpitations.

Diagnosis
Diagnosing sarcoidosis typically involves a combination of clinical evaluation, imaging studies, and laboratory tests. Key diagnostic steps include:
1. Chest X-ray: This is often the first imaging study performed. It can reveal enlarged lymph nodes in the chest or lung involvement.

2. CT Scan: A more detailed imaging study that can help assess the extent of lung involvement and detect granulomas in other organs.

3. Biopsy: A definitive diagnosis often requires a biopsy of affected tissue, showing non-caseating granulomas.

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

5. Pulmonary Function Tests: These assess lung function and can help determine the impact of sarcoidosis on respiratory health.

Treatment
The treatment of sarcoidosis depends on the severity of the disease and the organs involved. Many patients with mild cases may not require treatment, as the condition can resolve spontaneously. However, for those with significant symptoms or organ involvement, treatment options include:
1. Corticosteroids: Prednisone is the most commonly used medication to reduce inflammation and suppress the immune response. It is effective for managing symptoms and preventing complications.

2. Immunosuppressive Drugs: In cases where corticosteroids are ineffective or cause significant side effects, other immunosuppressive medications such as methotrexate, azathioprine, or mycophenolate mofetil may be used.

3. Biologic Agents: Newer treatments, such as TNF-alpha inhibitors, are being explored for patients with refractory sarcoidosis.

4. Symptomatic Treatment: This may include medications for specific symptoms, such as bronchodilators for respiratory issues or medications for heart arrhythmias.

Conclusion
Given your symptoms of fatigue, weight loss, low-grade fever, and night sweats, along with the concern for sarcoidosis raised by your healthcare provider, it is essential to follow up with further diagnostic testing as recommended. Sarcoidosis can be a challenging condition to manage, but with appropriate diagnosis and treatment, many patients can lead fulfilling lives. If you have further questions or concerns, discussing them with your healthcare provider is crucial to ensure you receive the best possible care tailored to your specific situation.

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