Clinical Presentation

Sarcoidosis typically presents in early adulthood, between ages 20 and 40. Although the disease is systemic, a spectrum of clinical manifestations may suggest the prognosis. The onset of fever, arthralgias, bilateral hilar adenopathy on chest radiograph, and a raised, reddish skin lesion along the anterior tibial surfaces (erythema nodosum) characterize Lofgren's syndrome, an acute, self-limiting form of sarcoidosis that often undergoes spontaneous remission and has a favorable prognosis. The insidious onset of dyspnea, dry cough, hilar adenopathy and infiltrates on chest film, new skin lesions of the trunk and extremities, and complaints of recent vision changes characterize a chronic progressive form of sarcoidosis marked by multiple flares of disease requiring repeated treatment throughout the patient's lifetime.

Symptoms that bring patients to medical attention most often emanate from the lungs, skin, or the eyes (uveitis and lacrimal gland enlargement). Diagnosis of sarcoidosis may be delayed if symptoms are attributed to more common lung diseases such as asthma or chronic bronchitis (Judson et al., 2003). Pulmonary symptoms may result from bronchial obstruction, either external compression caused by adenopathy or granulomas within the airways. Progressive disease may cause damage to the lung parenchyma, with a restrictive pattern of pulmonary function and decreased diffusion capacity, consistent with progressive interstitial lung damage. Clinical features associated with a worse outcome include the presence of lupus pernio, chronic uveitis, hyper-calcemia or nephrocalcinosis, nasal mucosal involvement and bone cysts. Neurosarcoidosis and cardiac involvement can be especially challenging to diagnose.

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