A 35yo man presents with progressive breathlessness. He gave a hx of polyarthralgia with
painful lesions on the shin. CXR: bilateral hilar lymphadenopathy. What’s the most likely dx?
a. Bronchial asthma
b. Cystic fibrosis
c. Sarcoidosis
d. Bronchiectasis
e. Pneumonia
answer: C
sarcoidosis
Epidemiology
• typically affects young and middle-aged patients
• higher incidence among African Americans and people at northern latitudes e.g. Scandinavia,
Canada
Signs and Symptoms
• asymptomatic, cough, dyspnea, fever, arthralgia, malaise, erythema nodosum, chest pain
• chest exam often normal
• common extrapulmonary manifestations
ƒ cardiac (arrhythmias, sudden death)
ƒ eye involvement (anterior or posterior uveitis)
ƒ skin involvement (skin papules, erythema nodosum, lupus pernio)
ƒ peripheral lymphadenopathy
ƒ arthralgia
ƒ hepatomegaly ± splenomegaly
• less common extra-pulmonary manifestations involve bone, CNS, and kidney, cardiac
(arrhythmias, sudden death)
• two acute sarcoid syndromes
ƒ Lofgren’s syndrome: fever, erythema nodosum, bilateral hilar lymphadenopathy, arthralgias
ƒ Heerfordt-Waldenstrom syndrome: fever, parotid enlargement, anterior uveitis, facial nerve
palsy
diagnosis: biopsy
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