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Sarcoidosis

Sarcoidosis is a disease that involves many systems of the body including the lungs. The cause of sarcoidosis is not known, though some physicians theorize that it is an autoimmune process. There may also be a genetic predisposition in the susceptibility of patients who develop sarcoidosis. Currently, local academic centers are studying the exact cause of sarcoidosis.

Approximately 90% of patients with sarcoidosis have lung involvement. Other organs that may be involved include the liver, skin, eyes, heart, and rarely the central nervous system. Sarcoid is diagnosed by demonstrating a specific pattern of inflammation termed noncaseating granulomas on a tissue specimen. Classically, this is from a small lung biopsy which is taken during bronchoscopy. Sarcoidosis is a diagnosis made after excluding other processes such as fungal infection or tuberculosis.

Sarcoid can have minimal manifestations such as a skin rash or an abnormal chest x-ray without any specific respiratory limitations or can present as a chronic and severe disease, causing significant respiratory limitations in some (fortunately, a minority) of patients. Many patients with sarcoid are just followed periodically in the physician's office and do not require treatment. These patients will be seen periodically to undergo a clinical evaluation. The physician may also check pulmonary function tests as well as a chest x-ray. Patients that have shortness of breath, cough, or other non-pulmonary symptoms, may require treatment. Prednisone remains the mainstay of treatment for sarcoidosis. Once prednisone is started, usually patients remain on this for one year, as if it is withdrawn too soon, a relapse may occur. Some patients require prolonged treatment with prednisone, while the physician always strives to keep the patient on the lowest possible dose. Keep in mind, that many other organ systems are affected by sarcoidosis, thus the patient should have periodic eye examinations and blood work.

In general, sarcoidosis can present in a wide variety of clinical scenarios from the asymptomatic patient who needs to no treatment to the patient who will require chronic steroids after they have failed tapering dosages.

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