Sarcoidosis: a Review for the Internist

Overview

Journal Intern Emerg Med

Publisher Springer

Specialties Emergency Medicine
General Medicine

Date 2018 Jan 5

PMID 29299831

Citations 57

Authors

Elena Bargagli

Antje Prasse

Affiliations

Soon will be listed here.

Abstract

Sarcoidosis is a systemic granulomatous lung disease of unknown origin affecting people of any age, mainly young adults. The disease is extremely heterogeneous with an unpredictable clinical course. Different phenotypes have been identified: an acute syndrome can be distinguished from subacute and chronic variants. About 20% of patients are chronically progressive and may develop lung fibrosis. Sarcoidosis usually involves the lungs and thoracic lymph nodes, although the skin, eyes, bones, liver, spleen, heart, upper respiratory tract and nervous system can also be affected. No reliable indicators of clinical outcome are available, and there is no single serological biomarker with demonstrated unequivocal diagnostic and prognostic value. Diagnosis requires histological confirmation although a presumptive diagnosis may be acceptable in special conditions. This review examines the diagnostic approach to sarcoidosis involving a multidisciplinary team of specialists in which the internist has the task of identifying all pulmonary and extrapulmonary localizations of the disease and of managing complications and comorbidities.

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References

Levitt D, Levitt M . Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states. Clin Exp Gastroenterol. 2017; 10:147-168. PMC: 5522668. DOI: 10.2147/CEG.S136803. View

Baughman R, Papanikolaou I . Current concepts regarding calcium metabolism and bone health in sarcoidosis. Curr Opin Pulm Med. 2017; 23(5):476-481. DOI: 10.1097/MCP.0000000000000400. View

Hebel R, Dubaniewicz-Wybieralska M, Dubaniewicz A . Overview of neurosarcoidosis: recent advances. J Neurol. 2014; 262(2):258-67. PMC: 4330460. DOI: 10.1007/s00415-014-7482-9. View

Kingah P, Alam M, Chugh K, Kamholz J, Samavati L . Role of Pulmonary Evaluation in Diagnosis of Neurosarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016; 33(3):209-215. View

Ivanisevic J, Kotur-Stevuljevic J, Stefanovic A, Spasic S, Vucinic Mihailovic V, Videnovic Ivanov J . Association of serum amyloid A and oxidative stress with paraoxonase 1 in sarcoidosis patients. Eur J Clin Invest. 2016; 46(5):418-24. DOI: 10.1111/eci.12610. View

Chaigne B, Guillevin L . Vasculitis for the internist: focus on ANCA-associated vasculitis. Intern Emerg Med. 2017; 12(5):577-585. DOI: 10.1007/s11739-017-1683-z. View

Elia F, Apra F, Crupi V . Understanding and improving decisions in clinical medicine (II): making sense of reasoning in practice. Intern Emerg Med. 2017; 13(2):287-289. DOI: 10.1007/s11739-017-1740-7. View

Duchemann B, Annesi-Maesano I, Jacobe de Naurois C, Sanyal S, Brillet P, Brauner M . Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris. Eur Respir J. 2017; 50(2). DOI: 10.1183/13993003.02419-2016. View

Minisola S, Cipriani C, Occhiuto M, Pepe J . New anabolic therapies for osteoporosis. Intern Emerg Med. 2017; 12(7):915-921. DOI: 10.1007/s11739-017-1719-4. View

10.

Lieberman J, SCHLEISSNER L, Nosal A, Sastre A, Mishkin F . Clinical correlations of serum angiotensin-converting enzyme (ACE) in sarcoidosis. A longitudinal study of serum ACE, 67gallium scans, chest roentgenograms, and pulmonary function. Chest. 1983; 84(5):522-8. DOI: 10.1378/chest.84.5.522. View

11.

Tyan C, Machuca T, Czarnecka K, Ko H, da Cunha Santos G, Boerner S . Performance of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Isolated Mediastinal and Hilar Lymphadenopathy. Respiration. 2017; 94(5):457-464. DOI: 10.1159/000479745. View

12.

Rottoli P, Bargagli E, Chidichimo C, Nuti D, Cintorino M, Ginanneschi C . Sarcoidosis with upper respiratory tract involvement. Respir Med. 2005; 100(2):253-7. DOI: 10.1016/j.rmed.2005.04.018. View

13.

Said G . Sarcoidosis of the peripheral nervous system. Handb Clin Neurol. 2013; 115:485-95. DOI: 10.1016/B978-0-444-52902-2.00027-8. View

14.

Ogawa Y, Saraya T, Fujiwara M, Takizawa H . Massive Neurosarcoidosis. Intern Med. 2017; 56(18):2537-2538. PMC: 5643190. DOI: 10.2169/internalmedicine.8217-16. View

15.

Silva M, Nunes H, Valeyre D, Sverzellati N . Imaging of Sarcoidosis. Clin Rev Allergy Immunol. 2015; 49(1):45-53. DOI: 10.1007/s12016-015-8478-7. View

16.

Velter C, Lipsker D . [Cutaneous panniculitis]. Rev Med Interne. 2016; 37(11):743-750. DOI: 10.1016/j.revmed.2016.05.008. View

17.

Carter J, Howe B, Inwards C . Conditions Simulating Primary Bone Neoplasms. Surg Pathol Clin. 2017; 10(3):731-748. DOI: 10.1016/j.path.2017.04.012. View

18.

Bargagli E, Magi B, Olivieri C, Bianchi N, Landi C, Rottoli P . Analysis of serum amyloid A in sarcoidosis patients. Respir Med. 2011; 105(5):775-80. DOI: 10.1016/j.rmed.2010.12.010. View

19.

Grunewald J, Eklund A . Löfgren's syndrome: human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med. 2008; 179(4):307-12. DOI: 10.1164/rccm.200807-1082OC. View

20.

Mortaz E, Gudarzi H, Tabarsi P, Adcock I, Masjedi M, Jamaati H . Flow cytometry applications in the study of immunological lung disorders. Iran J Allergy Asthma Immunol. 2014; 14(1):12-8. View