How to treat sarcoidosis?
A 56-year-old lady is suffering from dyspnea on exertion and increasing cough. She reported no fevers, chills, night sweats, or hemoptysis, however, did relate an
approximate 20-pound weight loss over 6 weeks prior to presentation. She reported no history of sick contacts or recent travel. Her past medical history was significant for hypertension, dyslipidemia, osteopenia, and idiopathic thrombocytopenic purpura. She does relate a history of sarcoidosis diagnosed 20 years prior to presentation where she had an asymptomatic left supraclavicular lymph node biopsied and confirmed to be sarcoidosis. She did not receive any medical therapy at that time and her adenopathy resolved spontaneously. What is sarcoidosis and how to treat?
@jay Sarcoidosis is characterized by noncaseating epithelioid granulomas that can affect virtually any organ system. The diagnosis of sarcoidosis requires the biopsy finding of noncaseating granulomas not caused by any other etiology. The disease most commonly involves the lungs but can also affect the liver, skin, heart, nervous, and endocrine systems. The exact etiology of sarcoidosis is unknown. Evidence points to a possible genetic component, infectious etiology, or potential exposure to environmental agents. Infectious organisms such as mycobacteria and Borrelia burgdorferi have been implicated as potential causes of sarcoidosis. Environmental exposure to beryllium, aluminum, and zirconium can result in a granulomatous response similar to that of sarcoidosis. Current theories suggests that the disease develops in genetically susceptible hosts who are exposed to certain antigens that trigger an overwhelming inflammatory immune response leading to granulomatous reactions.