Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Sarcoidosis 1319

SARCOIDOSIS

LAURA L. KOTH, MD

history & physical

History

■Elicit occupational or environmental exposures

■Symptoms vary depending on organs involved

■Hallmark of disease: clinically silent organ involvement with almost

50% of patients asymptomatic

■Fever, fatigue, weight loss (30%)

■Lungs involved (90%); dyspnea, dry cough, chest pain (50%)

■Hemoptysis rare

■Airway hyperreactivity (20%)

Signs & Symptoms

■Eyes: uveitis, conjunctivitis

■Eye pain, rashes, or joint pain

■Skin: erythema nodosum, lupus pernio

■Lungs: crackles <20% of patients

■Abdomen: 15–20% with splenomegaly, hepatomegaly

■Extremities: clubbing rare; palpable peripheral lymph nodes in 30%

■Neurologic: facial palsies

Common Presentations:

■Acute:

➣Lofgren’s syndrome (erythema nodosum, uveitis, hilar adenopa-

thy,+/−migratory arthritis)

➣Heerfordt’s syndrome (fever, parotid enlargement, anterior

uveitis, facial nerve palsy)

■Subacute:

➣<2 y duration; often spontaneous remission

■Chronic:

➣>2 y duration; often leads to fibrosis in affected organs

tests

Laboratory

■Basic Blood Tests

➣Peripheral blood counts: WBC, RBC, platelets

➣Serum chemistries: calcium, liver enzymes (AST, ALT, AP) crea-

tinine, BUN