Sarcoid

What is sarcoid?
Sarcoid is a unique disease, characterized by the formation of inflammatory nodules, called granulomas, in multiple organs. The most common site of these granulomas is the lung and the lymph nodes. No one knows what causes these nodules to form. Nevertheless once they develop, they can cause abnormal function in the organs they affect.

What are the symptoms of sarcoid?
Because sarcoid affects many different organs, the symptoms can be quite variable.

• Fever, sweats, chills
• Enlarged lymph nodes
• Shortness of breath, cough, wheezing
• Chest pain
• Skin rash, tiny red nodules
• Joint pain and swelling
• Visual disturbances with redness of the eye and pain
• Seizures

Sometimes sarcoid can be suspected from an abnormal test found by accident.

• Abnormal chest X-ray
• Anemia
• Chemistry tests of the liver
• CAT scan of the head or chest

How is the diagnosis of sarcoid made, once it is suspected?
The only real way to make a definitive diagnosis of sarcoid is with a biopsy of an involved organ. Often a biopsy of the lymph nodes or the lung must be done. Sometimes a skin biopsy will be sufficient. There is a special skin biopsy done after preparing the skin with a special chemical. This type of biopsy is called the Kveim test and it is only done at certain centers in the country. In most cases, some type of lung biopsy is necessary.

Can the diagnosis be made without a biopsy?
In certain cases the physician is forced to put together all of the circumstantial evidence from the Xrays and blood tests and make a presumptive diagnosis of sarcoid. But it makes the decision to treat that much harder.

How is the biopsy of the lung done?
There are 3 types of procedures

• Bronchoscopy with transbronchial biopsy - A skinny flexible scope is passed into the lung through the nose to inspect the airways and obtain tiny specimens of the lung with X-ray and visual guidance.
• Mediastinoscopy - A large tube is inserted in the center of the chest at the level of the neck to sample the large lymph nodes in the center of the chest.
• Open lung biopsy - An incision is made between the ribs and a large chunk of lung is taken.

  Once the diagnosis is made, what is the treatment?
  There is no one specific treatment for sarcoid. Since we can not cure it, we simply seek to assess the degree of activity. Depending on the degree of activity and the organs involved, we then try to control the level of activity and ìcool downì the sarcoid to reduce the damage it can do.

  The usual medications are steroids, not the anabolic steroids that weight lifters use (or abuse) , but antiinflammatory steroids, such as prednisone and cortisone. The steroids can be given intravenously or orally or sometimes by the inhaled route. Often high doses of the oral steroid, prednisone, needs to be taken for about 6-8 weeks. There are many variations, all quite legitimate, depending on the patientís particular situation.

  Unfortunately steroids have many complications that make us very wary about using them unless we have to:

  • Hypertension
  • Weight gain
  • Elevated blood sugar
  • Mood changes
  • Osteoporosis
  • Blurred vision
  • Cataracts
  • Acne
  • Fluid retention
  • Ulcers
  • Easy bruising

  What can I do to stay healthy if I have sarcoid?
  Once the diagnosis is made, the patient must be followed on a regular basis by a doctor who is knowledgeable in the field of sarcoid. Simple blood tests, breathing tests, and in some cases, a chest X-ray and EKG need to be done routinely at least once a year. A complete eye examination must also be done annually. If it is determined that steroids in some form must be taken, then instructions should be followed meticulously. In many cases consultants need to be brought into the case to assist in the overall management.

  • Neurologists
  • Cardiologists
  • Nephrologists
  • Ophthalmologists
  • Dermatologists
  • Pulmonologists

  What is the most important thing I must do if I have sarcoid? Ask questions. Follow directions. Be checked regularly

© 2010 Tricia Lukowski