Up to one-third of sarcoidosis patients are asymptomatic with 20-30% of pulmonary sarcoidosis being detected by CXR in asymptomatic individuals. Sarcoid manifests symptomatically in organs where it affects function or where it is readily observed. Löfgren's syndrome consists of hilar adenopathy, erythema nodosum, often with uveitis and acute arthritis presenting in one or both ankles spreading to involve other joints.
Disease manifestations of sarcoid include:
- Lung: >90% of pts with sarcoidosis will have lung involvement. Features include hilar adenopathy, infiltrates, interstitial pneumonitis, and fibrosis; airways may be involved and cause obstruction to airflow; pulmonary hypertension from direct vascular involvement or lung fibrosis.
- Lymph nodes: intrathoracic nodes enlarged in 75-90% of pts. Extrathoracic lymph nodes affected in up to 20%.
- Skin: >33% will have skin involvement; lesions include erythema nodosum, maculopapular lesions, subcutaneous nodules, and lupus pernio (indurated blue-purple shiny lesions around nasal bridge, eyes, cheeks).
- Eye: uveitis 30% in the United States (higher in other countries); may progress to blindness.
- Bone marrow and spleen—lymphopenia, anemia 20%, splenomegaly 5-10%.
- Liver: involved on biopsy in >50%; 20-30% abnormal liver function studies.
- Kidney—parenchymal disease <5%, nephrolithiasis, acute renal failure due to hypercalcemia 1-2%.
- Nervous system: occurs in 5-10%; cranial/peripheral neuropathy, chronic meningitis, pituitary involvement, space-occupying lesions, seizures.
- Heart: disturbances of rhythm and/or contractility, pericarditis.
- Musculoskeletal: involvement of bone or muscle occurs in 10%, bone lesions consist of cysts in areas of expanded bone or lattice-like changes; joint involvement includes acute arthropathy often of the ankles and chronic mono- or oligoarthritis of knee, ankle, proximal interphalangeal (PIP) joints.
- Constitutional symptoms—fever, weight loss, anorexia, fatigue.
- Other organ systems—hypercalcemia 10%, endocrine/reproductive, exocrine glands, GI, upper respiratory tract.