Teaching Pearls:

• Presents in 20-60 year old individuals. Diagnosis tends to occur 10 years earlier in blacks than Caucasians.
• Over 90% present with pulmonary findings on imaging.
• About 50% of patients with sarcoidosis are asymptomatic.
• About 30% of patients with sarcoidosis have extrapulmonary manifestations
• Extrapulmonary manifestations include:
  • Cutaneous – can be found on tattooed skin
  • Cardiac – monitor for conduction delays, infiltrative heart diseases
  • Lymph nodes, liver, spleen
  • GI
  • Renal
  • Systemic symptoms
• Differential Diagnosis
  • Infectious
    • HIV, TB, fungal lung diseases
  • Occupational/environmental toxin exposure
  • Hypersensitivity pneumonitis
  • Pneumoconiosis (Beryllium)
  • Langerhans Cell histiocytosis
  • Malignancy (lymphoma)
• Diagnosis is made with the following:
  • Clinical and radiographic findings
  • Excluding other potential causes
  • Tissue biopsy
• Lofgren’s syndrome
  • Erythema nodosum, bilateral hilar adenopathy, fever, arthritis
  • Biopsy not needed if Lofgren’s syndrome is present (high specificity)
  • Prognosis – fantastic; treatment – NSAIDs
  • A Boards favorite topic. (Very high yield)