Clinical features

In close to 50% of patients the disease is asymptomatic. Majority are detected during chest radigrography performed for other reasons (1).

The clinical presentation of sarcoidosis may vary according to several factors (2):

• ethnicity
  • asymptomatic presentations, erythema nodosum and hypercalcemia - more frequent in Europeans
  • symptomatic and mutisystemic presentations - common in Afro-Americans (3)
• sex - according to a large study of patients who were diagnosed with sarcoidosis recently, women were more likely to be aged 40 years or more with eye and neurological involvement and erythema nodosum while men were more likely to have hypercalcaemia (1)
• site, extent and/or activity of the granulomatous process
• mode of onset of the disease e.g. - Löfgren's syndrome is an acute presentation (2)

The usual mode of presentation includes:

• non-specific constitutional symptoms - fatigue, weight loss, fever or night sweats
• symptoms related to organ-specific involvement. These may include
• thoracic involvement - around 30%-60% are asymptomatic; commonly presents with dull ache, dyspnoea, dry cough and sometimes wheeze (1,4)
• cutaneous manifestations - erythema nodosum; lupus pernio; plaques, nodules, papules and scars; granulomata
• generalised lymphadenopathy may occur in about 10%
• ocular involvement - uveitis and uveoparotid fever; keratoconjunctivitis sicca in chronic sarcoidosis
• nervous system involvement - cranial nerve palsy; myopathy; neuropathy
• skeletal involvement - arthritis, myopathy
• cardiac involvement - heart block; cardiomyopathy
• liver and gut involvement
• hypercalcaemia and nephrocalcinosis
• parotid salivary gland swelling

Reference:

• (1) Dempsey OJ et al. Sarcoidosis. BMJ. 2009 Aug 28;339:b3206
• (2) Grutters JC et al. Chapter 9 - Sarcoidosis.Eur Respir Mon 2009;46:126-154
• (3) Nunes H et al. Sarcoidosis. Orphanet J Rare Dis. 2007;2:46