Sarcoidosis : Clinical Features

Comments:
Clinical Features of Sarcoidosis: Most patients present with respiratory symptoms of gradual onset, including shortness of breath, cough, chest pain, and hemoptysis. There may be constitutional symptoms such as fever, weight loss, anorexia, and night sweats. Many patients are asymptomatic and the disease is discovered incidentally as bilateral hilar lymphadenopathy on imaging studies or at autopsy.

A small proportion of cases present with peripheral lymphadenopathy, skin lesions (erythema nodosum, painless subcutaneous nodules), eye involvement (sicca syndrome, iritis, iridocyclitis), or hepatosplenomegaly. Some patients develop hyperparathyroidism due to the secretion of a PTH-related protein by the granuloma cells.

The clinical course is variable. About 65% to 70% of patients go into remission (spontaneous or steroid therapy-induced) without residual damage, 20% suffer from some loss of pulmonary function or visual impairment, and the remaining 10% to 15% die of progressive pulmonary fibrosis and right heart failure.

The image shows numerous confluent non-necrotizing granulomas effacing the nodal architecture.