A process that covers the diagnosis, staging, and long-term follow-up of sarcoidosis — which can affect the lungs and other organs — using advanced imaging, biopsy, and laboratory tests.
Indication
- Unexplained bilateral hilar lymphadenopathy (lymph node enlargement at the lung hila)
- Chronic dry cough, shortness of breath, and chest pain
- Skin lesions (erythema nodosum, lupus pernio)
- Eye involvement such as uveitis (inflammation of the eye)
- Unexplained systemic symptoms (fever, weight loss, fatigue)
- Elevated serum ACE or calcium levels
- Suspicion of cardiac or neurological involvement
Preparation
- Detailed medical history and physical examination
- No smoking for 4 hours before pulmonary function tests
- 6-8 hours of fasting if bronchoscopy is planned
- Listing of current medications
- Renal function tests before advanced imaging
How it's performed
- Chest X-ray and high-resolution thoracic CT (HRCT)
- Pulmonary function test and carbon monoxide diffusing capacity (DLCO)
- Serum ACE, calcium, vitamin D, and complete blood count
- Bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy
- If needed, PET-CT, cardiac MRI, or skin/lymph node biopsy
- Multidisciplinary evaluation (pulmonology, ophthalmology, cardiology, dermatology)
Post-procedure
- Treatment decision based on disease stage (approximately 60% of stage 1 patients show spontaneous remission)
- Systemic corticosteroid (prednisolone) therapy in stages 2-3 and with organ involvement
- Second-line agents such as methotrexate or azathioprine in steroid-unresponsive cases
- Follow-up every 3-6 months with pulmonary function tests and imaging
- Annual evaluation for eye, cardiac, and liver involvement
Risks
- Pulmonary fibrosis may develop in untreated chronic forms
- Side effects of steroids (weight gain, bone loss, elevated blood sugar)
- Risk of arrhythmia in cardiac involvement
- Risk of vision loss in eye involvement
- Disease flare (relapse) may occur after treatment is stopped
FAQ
Is sarcoidosis contagious?
No, sarcoidosis is not a contagious disease. It develops as a result of an exaggerated immune system response.
Does every patient need treatment?
No. In mild cases with limited organ involvement, spontaneous remission is seen in approximately 60% of patients, and follow-up alone may be sufficient.
How long is the duration of treatment?
Steroid therapy generally lasts 6-24 months; the dose is gradually tapered according to the disease response.
Are lifestyle changes required?
Smoking cessation, a balanced diet, and regular follow-up are important. Excessive vitamin D supplementation should be avoided.
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