pulmonary sarcoidosis

Common Signs and Symptoms of Pulmonary Sarcoidosis

Pulmonary sarcoidosis, a type of lung disease caused by inflammation, can manifest in various ways, affecting individuals differently. The following are some common signs and symptoms associated with this condition:

• Shortness of breath (dyspnea): A persistent feeling of being unable to catch one's breath, even when sitting or lying down [6][10].
• Persistent dry cough: A hacking or wheezing cough that persists for weeks or months, often accompanied by chest pain [5][7][11].
• Chest pain: Pain or discomfort in the chest area, which can be sharp, dull, or aching in nature [4][7][12].
• Fatigue and malaise: Feeling tired, weak, or generally unwell, even after resting or engaging in light physical activity [1][10].
• Wheezing: A high-pitched whistling sound while breathing out, often accompanied by coughing [6][11].
• Lung stiffness (restriction): Abnormal stiffness of the lungs, making it difficult to breathe deeply or fully expand the chest cavity [14].

Other Possible Symptoms

In addition to these common symptoms, some people with pulmonary sarcoidosis may experience:

• Skin rashes or raised bumps: Skin manifestations, such as redness, itching, or small bumps on the skin [4].
• Eye irritation or dryness: Dryness, itchiness, or redness of the eyes, which can be accompanied by blurred vision or sensitivity to light [4].
• Joint pain or stiffness: Pain or stiffness in the joints, particularly in the hands and feet [4].

Important Note

It's essential to note that not everyone with pulmonary sarcoidosis will experience all of these symptoms. Some people may have no symptoms at all, while others may exhibit a combination of these signs and symptoms.

References:

[1] Context 1 [4] Context 4 [5] Context 5 [6] Context 6 [7] Context 7 [10] Context 10 [11] Context 11 [14] Context 14

Diagnostic Tests for Pulmonary Sarcoidosis

Pulmonary sarcoidosis, a type of lung disease caused by inflammation and lumps called granulomas, can be challenging to diagnose due to its varied presentations and lack of specific diagnostic tests. However, various diagnostic tests can help exclude other disorders and determine the affected body systems.

Imaging Tests

• Chest X-ray: A chest radiograph is central to evaluation, showing how the lungs look [7]. Air trapping is a common feature in sarcoidosis that can be supported with imaging studies [7].
• Chest CT scan: This test provides a detailed image of the lungs and can show signs of sarcoidosis [6].
• MRI (Magnetic Resonance Imaging): MRIs can be used to look for signs of sarcoidosis in the body, but their role is not as well-established as other imaging tests [3].

Functional Tests

• Pulmonary function testing: Pulmonary function tests measure how well the lungs work and can assess the severity of respiratory impairment caused by pulmonary sarcoidosis [11].
• Electrocardiogram (EKG or ECG): An electrocardiogram checks the electrical activity of the heart, which can be affected by cardiac sarcoidosis [4].

Blood Tests

• Lab tests: Blood or urine tests are used to see how well the liver, kidneys, and other organs work, as pulmonary sarcoidosis can cause damage to these organs [3].
• Additional blood tests: These tests may be ordered to determine the extent of organ involvement and monitor disease progression.

Other Tests

• Biopsy: A biopsy is a minor surgical procedure that involves taking a tissue sample from the affected area for examination under a microscope. It can provide pathologic evidence of noncaseating granulomas, which is one of the diagnostic criteria for sarcoidosis [13].
• Eye exams: Eye exams look for eye damage caused by sarcoidosis, even if symptoms are not present.
• Neurological tests: Neurological tests, such as electromyography or nerve conduction tests, can detect problems with the nervous system caused by sarcoidosis.

Diagnostic Criteria

The diagnosis of pulmonary sarcoidosis relies on three criteria: (1) a compatible clinical and radiologic presentation, (2) pathologic evidence of noncaseating granulomas, and (3) exclusion of other diseases [13].

References: [1] Carmona EM, et al. Pulmonary sarcoidosis: Diagnosis and treatment. Mayo Clinic Proceedings. 2016;91(10):1475-1484. [2] Heart Rhythm Society diagnostic criteria rely on either CMR or cPET for diagnosis of cardiac sarcoidosis [10]. [3] Neurological tests, such as electromyography, evoked potentials, spinal taps, or nerve conduction tests, look for problems with the nervous system caused by sarcoidosis. Eye exams look for eye damage, which can occur without symptoms in a person with sarcoidosis. Lung function tests check whether you have breathing problems [12]. [4] Pulmonary function testing — Pulmonary function tests (PFTs), including spirometry and diffusing capacity for carbon monoxide (DLCO) are obtained in patients with pulmonary sarcoidosis to assess the severity of respiratory impairment and to monitor the course of disease. PFTs are not a reliable means for detecting the presence or extent of [11]. [5] Pulmonary sarcoidosis is a lung disease that causes inflammation and lumps called granulomas. Many cases go away with no treatment or short-term medications. Diagnosis and Tests. How is pulmonary sarcoidosis diagnosed? If a healthcare provider suspects pulmonary sarcoidosis, they may order the following tests: Biopsy, [14]. [6] See your healthcare provider for a diagnosis. How is pulmonary sarcoidosis diagnosed? In addition to a complete health history and physical exam, you may have tests such as: Chest X-ray. This imaging test is used to assess the lungs, as well as the heart. Chest X-rays may show important information about the size, shape, and location of [15]. [7] A chest radiograph is central to evaluation, showing how the lungs look [7]. Air trapping is a common feature in sarcoidosis that can be supported with imaging studies [7]. [8] Pulmonary function testing — Pulmonary function tests (PFTs), including spirometry and diffusing capacity for carbon monoxide (DLCO) are obtained in patients with pulmonary sarcoidosis to assess the severity of respiratory impairment and to monitor the course of disease. PFTs are not a reliable means for detecting the presence or extent of [11]. [9] Pulmonary function testing — Pulmonary function tests (PFTs), including spirometry and diffusing capacity for carbon monoxide (DLCO) are obtained in patients with pulmonary sarcoidosis to assess the severity of respiratory impairment and to monitor the course of disease. PFTs are not a reliable means for detecting the presence or extent of [11]. [10] Heart Rhythm Society diagnostic criteria rely on either CMR or cPET for diagnosis of cardiac sarcoidosis [10]. [11] Pulmonary function testing — Pulmonary function tests (PFTs), including spirometry and diffusing capacity for carbon monoxide (DLCO) are obtained in patients with pulmonary sarcoidosis to assess the severity of respiratory impairment and to monitor the course of disease. PFTs are not a reliable means for detecting the presence or extent of [11]. [12] Neurological tests, such as electromyography, evoked potentials, spinal taps, or nerve conduction tests, look for problems with the nervous system caused by sarcoidosis. Eye exams look for eye damage, which can occur without symptoms in a person with sarcoidosis. Lung function tests check whether you have breathing problems [12]. [13] Diagnosis of sarcoidosis relies on three criteria: (1) a compatible clinical and radiologic presentation, (2) pathologic evidence of noncaseating granulomas, and (3) exclusion of other diseases [13]. [14] Pulmonary sarcoidosis is a lung disease that causes inflammation and lumps called granulomas. Many cases go away with no treatment or short-term medications. Diagnosis and Tests. How is pulmonary sarcoidosis diagnosed? If a healthcare provider suspects pulmonary sarcoidosis, they may order the following tests: Biopsy, [14]. [15] See your healthcare provider for a diagnosis. How is pulmonary sarcoidosis diagnosed? In addition to a complete health history and physical exam, you may have tests such as: Chest X-ray. This imaging test is used to assess the lungs, as well as the heart. Chest X-rays may show important information about the size, shape, and location of [15].

Treatment Options for Pulmonary Sarcoidosis

Pulmonary sarcoidosis, a type of lung disease characterized by inflammation and granuloma formation, can be effectively managed with various treatment options. The primary goal of treatment is to manage symptoms, prevent organ damage, and improve quality of life.

Corticosteroids: The Mainstay of Therapy

Corticosteroids are the first-line treatment for pulmonary sarcoidosis. These powerful anti-inflammatory drugs can be administered orally or topically, depending on the severity and location of the disease. According to search results [5] and [7], corticosteroids, such as prednisone, are usually given daily and then tapered over a 6-month course.

Prednisone: A Commonly Prescribed Corticosteroid

Prednisone is one of the most commonly prescribed corticosteroids for sarcoidosis. Patients typically take a daily dose between 5 and 40 mg [4]. The initial treatment with prednisone can be effective in relieving symptoms, but it's essential to monitor patients closely for potential side effects.

Other Treatment Options

In addition to corticosteroids, other medications may be prescribed to manage pulmonary sarcoidosis. These include:

• Respiratory medications: To alleviate symptoms such as shortness of breath and cough
• Oxygen therapy: To increase oxygen levels in the blood
• Immunosuppressive drugs: Such as methotrexate or mycophenolate mofetil (MMF), which may be used to treat more severe cases

Treatment Outcomes

The effectiveness of treatment for pulmonary sarcoidosis can vary depending on individual factors. Some patients may experience significant improvement in symptoms and lung function, while others may require ongoing management [11]. It's essential to work closely with a healthcare provider to determine the best course of treatment.

References:

[4] Apr 29, 2019 — Prednisone is one of the most commonly prescribed corticosteroids for sarcoidosis. [5] Jul 21, 2024 — Corticosteroids are usually given daily and then tapered over a 6-month course. [7] A randomized placebo-controlled study reported significant improvement in symptoms and lung function with chloroquine (CQ) treatment. [11] A randomized placebo-controlled study of 18 pulmonary sarcoidosis patients, initially treated for 6 months with CQ 750 mg/day, tapering every 2 months to 250 mg, reported a significant improvement in symptoms and lung function.

Differential Diagnosis of Pulmonary Sarcoidosis

Pulmonary sarcoidosis, a multisystem inflammatory disease of unknown etiology, can be challenging to diagnose due to its nonspecific symptoms and diverse clinical presentations. The differential diagnosis for pulmonary sarcoidosis is broad and includes various conditions that can mimic the disease.

Key Conditions to Consider:

• Sarcoid-like reaction: A condition characterized by nonnecrotizing granulomas, which can occur in other diseases such as malignant neoplasms, infections (fungal, tuberculosis, and atypical mycobacteria), common variable immunodeficiency syndrome, and inhalational injuries.
• Tuberculosis (TB): A bacterial infection that can cause pulmonary symptoms similar to sarcoidosis. In countries where TB is endemic, it should always be considered in the differential diagnosis of patients suspected of having sarcoidosis [6].
• Cat scratch disease: An important differential diagnosis of sarcoidosis that mainly affects the lymphatic system. Chronic infections such as toxoplasmosis can also be considered [7].
• Lymphoma: A type of cancer that can cause pulmonary symptoms similar to sarcoidosis.
• Fungal infections: Certain fungal infections, such as histoplasmosis and coccidioidomycosis, can cause granulomatous inflammation in the lungs, mimicking sarcoidosis.

Other Conditions to Consider:

• Malignant neoplasms: Such as lymphoma, which can cause pulmonary symptoms similar to sarcoidosis.
• Fungal infections: Such as histoplasmosis and coccidioidomycosis, which can cause granulomatous inflammation in the lungs, mimicking sarcoidosis.
• Common variable immunodeficiency syndrome: A condition characterized by impaired immune function, which can increase the risk of developing pulmonary symptoms similar to sarcoidosis.

Importance of Customized Differential Diagnosis:

The differential diagnosis of pulmonary sarcoidosis requires customization, taking into account not only the individual's clinical history and presentation but also risk factors, and can depend on geographic situation [13]. A sharp clinical eye and sufficient knowledge and experience with the disease are essential for accurate diagnosis.

References:

• [1] The differential diagnosis with sarcoidosis is rarely difficult unless the lung is the only site involved, with condensations or noncavitated nodular lesions. However, differences with sarcoidosis include the absence of co-existing perilymphatic micronodular lesions and of lymphadenopathy (46).
• [3] by N Bernardinello · 2021 · Cited by 33 — This review critically examines the diagnostic approach to sarcoidosis and emphasizes the importance of a customized differential diagnosis.
• [7] Diagnosing pulmonary sarcoidosis raises challenges due to both the absence of a specific diagnostic criterion and the varied presentations capable of mimicking many other conditions. The aim of this review is to help non-sarcoidosis experts establish optimal differential-diagnosis strategies tailored to each situation.
• [13] Differential diagnosis of sarcoidosis requires customization, taking into account not only the individual’s clinical history and presentation but also risk factors, and can depend on geographic situation.