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Sarcoidosis - Wikipedia
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id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> <li id="toc-Respiratory_tract" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Respiratory_tract"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Respiratory tract</span> </div> </a> <ul id="toc-Respiratory_tract-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Skin" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Skin"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Skin</span> </div> </a> <ul id="toc-Skin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Heart" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Heart"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3</span> <span>Heart</span> </div> </a> <ul id="toc-Heart-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Eye" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Eye"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4</span> <span>Eye</span> </div> </a> <ul id="toc-Eye-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Nervous_system" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Nervous_system"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5</span> <span>Nervous system</span> </div> </a> <ul id="toc-Nervous_system-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Endocrine_and_exocrine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Endocrine_and_exocrine"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.6</span> <span>Endocrine and exocrine</span> </div> </a> <ul id="toc-Endocrine_and_exocrine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Gastrointestinal_and_genitourinary" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Gastrointestinal_and_genitourinary"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.7</span> <span>Gastrointestinal and genitourinary</span> </div> </a> <ul id="toc-Gastrointestinal_and_genitourinary-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Blood" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Blood"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.8</span> <span>Blood</span> </div> </a> <ul id="toc-Blood-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bone,_joints,_and_muscles" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Bone,_joints,_and_muscles"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.9</span> <span>Bone, joints, and muscles</span> </div> </a> <ul id="toc-Bone,_joints,_and_muscles-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Cause" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Cause"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Cause</span> </div> </a> <button aria-controls="toc-Cause-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Cause subsection</span> </button> <ul id="toc-Cause-sublist" class="vector-toc-list"> <li id="toc-Genetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genetics"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Genetics</span> </div> </a> <ul id="toc-Genetics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Infectious_agents" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Infectious_agents"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Infectious agents</span> </div> </a> <ul id="toc-Infectious_agents-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Autoimmune" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Autoimmune"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Autoimmune</span> </div> </a> <ul id="toc-Autoimmune-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <button aria-controls="toc-Pathophysiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Pathophysiology subsection</span> </button> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> <li id="toc-Histopathology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Histopathology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Histopathology</span> </div> </a> <ul id="toc-Histopathology-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Classification" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Classification"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Classification</span> </div> </a> <ul id="toc-Classification-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Antimetabolites" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antimetabolites"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Antimetabolites</span> </div> </a> <ul id="toc-Antimetabolites-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunosuppressants" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunosuppressants"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Immunosuppressants</span> </div> </a> <ul id="toc-Immunosuppressants-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Specific_organ_treatments" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Specific_organ_treatments"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Specific organ treatments</span> </div> </a> <ul id="toc-Specific_organ_treatments-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Symptoms" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Symptoms"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Symptoms</span> </div> </a> <ul id="toc-Symptoms-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Prognosis</span> </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>History</span> </div> </a> <button aria-controls="toc-History-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle History subsection</span> </button> <ul id="toc-History-sublist" class="vector-toc-list"> <li id="toc-Etymology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Etymology"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.1</span> <span>Etymology</span> </div> </a> <ul id="toc-Etymology-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Society and culture</span> </div> </a> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pregnancy" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pregnancy"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>Pregnancy</span> </div> </a> <ul id="toc-Pregnancy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Sarcoidosis</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 50 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-50" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">50 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%BA%D8%B1%D9%86%D8%A7%D9%88%D9%8A%D8%A9_(%D8%B3%D8%A7%D8%B1%D9%83%D9%88%D9%8A%D8%AF)" title="غرناوية (ساركويد) – Arabic" lang="ar" hreflang="ar" data-title="غرناوية (ساركويد)" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Sarkoidoz" title="Sarkoidoz – Azerbaijani" lang="az" hreflang="az" data-title="Sarkoidoz" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D8%B3%D8%A7%D8%B1%DA%A9%D9%88%DB%8C%D8%AF%D9%88%D8%B3%DB%8C%D8%B2" title="سارکویدوسیز – South Azerbaijani" lang="azb" hreflang="azb" data-title="سارکویدوسیز" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Sarkoidoza" title="Sarkoidoza – Bosnian" lang="bs" hreflang="bs" data-title="Sarkoidoza" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Sarco%C3%AFdosi" title="Sarcoïdosi – Catalan" lang="ca" hreflang="ca" data-title="Sarcoïdosi" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Sarkoid%C3%B3za" title="Sarkoidóza – Czech" lang="cs" hreflang="cs" data-title="Sarkoidóza" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Sarkoidose" title="Sarkoidose – Danish" lang="da" hreflang="da" data-title="Sarkoidose" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Sarkoidose" title="Sarkoidose – German" lang="de" hreflang="de" data-title="Sarkoidose" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Sarkoidoos" title="Sarkoidoos – Estonian" lang="et" hreflang="et" data-title="Sarkoidoos" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A3%CE%B1%CF%81%CE%BA%CE%BF%CE%B5%CE%AF%CE%B4%CF%89%CF%83%CE%B7" title="Σαρκοείδωση – Greek" lang="el" hreflang="el" data-title="Σαρκοείδωση" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Sarcoidosis" title="Sarcoidosis – Spanish" lang="es" hreflang="es" data-title="Sarcoidosis" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Sarkoidozo" title="Sarkoidozo – Esperanto" lang="eo" hreflang="eo" data-title="Sarkoidozo" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Sarkoidosi" title="Sarkoidosi – Basque" lang="eu" hreflang="eu" data-title="Sarkoidosi" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B3%D8%A7%D8%B1%DA%A9%D9%88%D8%A6%DB%8C%D8%AF%D9%88%D8%B2" title="سارکوئیدوز – Persian" lang="fa" hreflang="fa" data-title="سارکوئیدوز" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Sarco%C3%AFdose" title="Sarcoïdose – French" lang="fr" hreflang="fr" data-title="Sarcoïdose" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Sarcoidose" title="Sarcoidose – Galician" lang="gl" hreflang="gl" data-title="Sarcoidose" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%82%AC%EB%A5%B4%EC%BD%94%EC%9D%B4%EB%93%9C%EC%A6%9D" title="사르코이드증 – Korean" lang="ko" hreflang="ko" data-title="사르코이드증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8D%D5%A1%D6%80%D5%AF%D5%B8%D5%AB%D5%A4%D5%B8%D5%A6" title="Սարկոիդոզ – Armenian" lang="hy" hreflang="hy" data-title="Սարկոիդոզ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B8%E0%A4%BE%E0%A4%B0%E0%A4%95%E0%A5%89%E0%A4%87%E0%A4%A1%E0%A5%8B%E0%A4%B8%E0%A4%BF%E0%A4%B8" title="सारकॉइडोसिस – Hindi" lang="hi" hreflang="hi" data-title="सारकॉइडोसिस" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Sarkoidoza" title="Sarkoidoza – Croatian" lang="hr" hreflang="hr" data-title="Sarkoidoza" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Sarkoidosis" title="Sarkoidosis – Indonesian" lang="id" hreflang="id" data-title="Sarkoidosis" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Sarcoidosi" title="Sarcoidosi – Italian" lang="it" hreflang="it" data-title="Sarcoidosi" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A1%D7%A8%D7%A7%D7%95%D7%90%D7%99%D7%93%D7%95%D7%96%D7%99%D7%A1" title="סרקואידוזיס – Hebrew" lang="he" hreflang="he" data-title="סרקואידוזיס" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%B8%E0%B2%BE%E0%B2%B0%E0%B3%8D%E0%B2%95%E0%B3%8A%E0%B2%AF%E0%B2%BF%E0%B2%A1%E0%B3%8B%E0%B2%B8%E0%B2%BF%E0%B2%B8%E0%B3%8D" title="ಸಾರ್ಕೊಯಿಡೋಸಿಸ್ – Kannada" lang="kn" hreflang="kn" data-title="ಸಾರ್ಕೊಯಿಡೋಸಿಸ್" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target"><span>ಕನ್ನಡ</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%A1%D0%B0%D1%80%D0%BA%D0%BE%D0%B8%D0%B4%D0%BE%D0%B7" title="Саркоидоз – Kazakh" lang="kk" hreflang="kk" data-title="Саркоидоз" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-ht mw-list-item"><a href="https://ht.wikipedia.org/wiki/Sakoydosis" title="Sakoydosis – Haitian Creole" lang="ht" hreflang="ht" data-title="Sakoydosis" data-language-autonym="Kreyòl ayisyen" data-language-local-name="Haitian Creole" class="interlanguage-link-target"><span>Kreyòl ayisyen</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Sarcoidosis" title="Sarcoidosis – Latin" lang="la" hreflang="la" data-title="Sarcoidosis" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lb mw-list-item"><a href="https://lb.wikipedia.org/wiki/Sarkoidos" title="Sarkoidos – Luxembourgish" lang="lb" hreflang="lb" data-title="Sarkoidos" data-language-autonym="Lëtzebuergesch" data-language-local-name="Luxembourgish" class="interlanguage-link-target"><span>Lëtzebuergesch</span></a></li><li class="interlanguage-link interwiki-lfn mw-list-item"><a href="https://lfn.wikipedia.org/wiki/Sarcoidose" title="Sarcoidose – Lingua Franca Nova" lang="lfn" hreflang="lfn" data-title="Sarcoidose" data-language-autonym="Lingua Franca Nova" data-language-local-name="Lingua Franca Nova" class="interlanguage-link-target"><span>Lingua Franca Nova</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Sarkoidosis" title="Sarkoidosis – Malay" lang="ms" hreflang="ms" data-title="Sarkoidosis" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Sarco%C3%AFdose" title="Sarcoïdose – Dutch" lang="nl" hreflang="nl" data-title="Sarcoïdose" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%82%B5%E3%83%AB%E3%82%B3%E3%82%A4%E3%83%89%E3%83%BC%E3%82%B7%E3%82%B9" title="サルコイドーシス – Japanese" lang="ja" hreflang="ja" data-title="サルコイドーシス" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Sarkoidose" title="Sarkoidose – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Sarkoidose" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Sarkoidose" title="Sarkoidose – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Sarkoidose" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B8%E0%AC%BE%E0%AC%B0%E0%AD%8D%E0%AC%95%E0%AC%8F%E0%AC%A1%E0%AD%8B%E0%AC%B8%E0%AC%BF%E0%AC%B8%E0%AD%8D" title="ସାର୍କଏଡୋସିସ୍ – Odia" lang="or" hreflang="or" data-title="ସାର୍କଏଡୋସିସ୍" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Sarkaidoz" title="Sarkaidoz – Uzbek" lang="uz" hreflang="uz" data-title="Sarkaidoz" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Sarkoidoza" title="Sarkoidoza – Polish" lang="pl" hreflang="pl" data-title="Sarkoidoza" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Sarcoidose" title="Sarcoidose – Portuguese" lang="pt" hreflang="pt" data-title="Sarcoidose" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A1%D0%B0%D1%80%D0%BA%D0%BE%D0%B8%D0%B4%D0%BE%D0%B7" title="Саркоидоз – Russian" lang="ru" hreflang="ru" data-title="Саркоидоз" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Sarkoidoza" title="Sarkoidoza – Albanian" lang="sq" hreflang="sq" data-title="Sarkoidoza" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Sarcoidosis" title="Sarcoidosis – Simple English" lang="en-simple" hreflang="en-simple" data-title="Sarcoidosis" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Sarkoidoza" title="Sarkoidoza – Slovenian" lang="sl" hreflang="sl" data-title="Sarkoidoza" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A1%D0%B0%D1%80%D0%BA%D0%BE%D0%B8%D0%B4%D0%BE%D0%B7%D0%B0" title="Саркоидоза – Serbian" lang="sr" hreflang="sr" data-title="Саркоидоза" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Sarkoidoza" title="Sarkoidoza – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Sarkoidoza" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Sarkoidoosi" title="Sarkoidoosi – Finnish" lang="fi" hreflang="fi" data-title="Sarkoidoosi" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Sarkoidos" title="Sarkoidos – Swedish" lang="sv" hreflang="sv" data-title="Sarkoidos" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a href="https://tt.wikipedia.org/wiki/%D0%A1%D0%B0%D1%80%D0%BA%D0%BE%D0%B8%D0%B4%D0%BE%D0%B7" title="Саркоидоз – Tatar" lang="tt" hreflang="tt" data-title="Саркоидоз" data-language-autonym="Татарча / tatarça" data-language-local-name="Tatar" class="interlanguage-link-target"><span>Татарча / tatarça</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Sarkoidoz" title="Sarkoidoz – Turkish" lang="tr" hreflang="tr" data-title="Sarkoidoz" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A1%D0%B0%D1%80%D0%BA%D0%BE%D1%97%D0%B4%D0%BE%D0%B7" title="Саркоїдоз – Ukrainian" lang="uk" hreflang="uk" data-title="Саркоїдоз" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E7%BB%93%E8%8A%82%E7%97%85" title="结节病 – Chinese" lang="zh" hreflang="zh" data-title="结节病" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span 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class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Abnormal formation of clumps of inflammatory cells (granulomata)</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Sarcoidosis</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Sarcoïdosis, sarcoid, Besnier–Boeck–Schaumann disease<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Chest_X-ray_of_sarcoidosis_nodules.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e6/Chest_X-ray_of_sarcoidosis_nodules.png/220px-Chest_X-ray_of_sarcoidosis_nodules.png" decoding="async" width="220" height="202" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e6/Chest_X-ray_of_sarcoidosis_nodules.png/330px-Chest_X-ray_of_sarcoidosis_nodules.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e6/Chest_X-ray_of_sarcoidosis_nodules.png/440px-Chest_X-ray_of_sarcoidosis_nodules.png 2x" data-file-width="1105" data-file-height="1017" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Chest X-ray showing the typical nodularity of sarcoidosis, predominantly in the <a href="/wiki/Root_of_the_lung" title="Root of the lung">hila</a> of the lungs.</td></tr><tr><th scope="row" class="infobox-label">Pronunciation</th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"><ul><li>sar-koy-DOH-sis </li></ul></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a>, <a href="/wiki/Immunology" title="Immunology">immunology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"><div class="plainlist"><ul><li>Depends on the organ involved<sup id="cite_ref-NIH2013What_2-0" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li><li><b>Lungs</b>: <a href="/wiki/Wheezing" class="mw-redirect" title="Wheezing">wheezing</a>, cough, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>, chest pain<sup id="cite_ref-NIH2013Sym_3-0" class="reference"><a href="#cite_note-NIH2013Sym-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li><li><b>Skin</b>: lumps, ulcers, discolored skin<sup id="cite_ref-NIH2013Sym_3-1" class="reference"><a href="#cite_note-NIH2013Sym-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li><li><b>Children</b>: weight loss, bone pain, feeling tired<sup id="cite_ref-NIH2013Sym_3-2" class="reference"><a href="#cite_note-NIH2013Sym-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li></ul></div></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">20–50 years old <br /> More common in women<sup id="cite_ref-NIH2013Risk_4-0" class="reference"><a href="#cite_note-NIH2013Risk-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">Few years to long term<sup id="cite_ref-NIH2013What_2-1" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Wj2015_5-0" class="reference"><a href="#cite_note-Wj2015-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">Unknown<sup id="cite_ref-NIH2013What_2-2" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Family history<sup id="cite_ref-NIH2013Risk_4-1" class="reference"><a href="#cite_note-NIH2013Risk-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms and <a href="/wiki/Tissue_biopsy" class="mw-redirect" title="Tissue biopsy">tissue biopsy</a><sup id="cite_ref-Gov2015_6-0" class="reference"><a href="#cite_note-Gov2015-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Tuberculosis" title="Tuberculosis">Tuberculosis</a>, <a href="/wiki/Lymphoma" title="Lymphoma">lymphoma</a>, <a href="/wiki/Infectious_mononucleosis" title="Infectious mononucleosis">infectious mononucleosis</a>, <a href="/wiki/Pulmonary_eosinophilia" class="mw-redirect" title="Pulmonary eosinophilia">pulmonary eosinophilia</a><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Ibuprofen" title="Ibuprofen">Ibuprofen</a>, <a href="/wiki/Prednisone" title="Prednisone">prednisone</a>, <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a><sup id="cite_ref-Dr2014_8-0" class="reference"><a href="#cite_note-Dr2014-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Jud2016_9-0" class="reference"><a href="#cite_note-Jud2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Mortality 1–7%<sup id="cite_ref-Wj2015_5-1" class="reference"><a href="#cite_note-Wj2015-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">1.9 million with <a href="/wiki/Interstitial_lung_disease" title="Interstitial lung disease">interstitial lung disease</a> (2015)<sup id="cite_ref-GBD2015Pre_10-0" class="reference"><a href="#cite_note-GBD2015Pre-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Deaths</th><td class="infobox-data">122,000 with interstitial lung disease (2015)<sup id="cite_ref-GBD2015De_11-0" class="reference"><a href="#cite_note-GBD2015De-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Sarcoidosis</b> (<span class="rt-commentedText nowrap"><span class="IPA nopopups noexcerpt" lang="en-fonipa"><a href="/wiki/Help:IPA/English" title="Help:IPA/English">/<span style="border-bottom:1px dotted"><span title="/ˌ/: secondary stress follows">ˌ</span><span title="'s' in 'sigh'">s</span><span title="/ɑːr/: 'ar' in 'far'">ɑːr</span><span title="'k' in 'kind'">k</span><span title="/ɔɪ/: 'oi' in 'choice'">ɔɪ</span><span title="/ˈ/: primary stress follows">ˈ</span><span title="'d' in 'dye'">d</span><span title="/oʊ/: 'o' in 'code'">oʊ</span><span title="'s' in 'sigh'">s</span><span title="/ɪ/: 'i' in 'kit'">ɪ</span><span title="'s' in 'sigh'">s</span></span>/</a></span></span>; also known as <b>Besnier–Boeck–Schaumann disease</b>) is a disease involving abnormal collections of <a href="/wiki/White_blood_cell" title="White blood cell">inflammatory cells</a> that form lumps known as <a href="/wiki/Granulomata" class="mw-redirect" title="Granulomata">granulomata</a>.<sup id="cite_ref-NIH2013What_2-3" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The disease usually begins in the <a href="/wiki/Lungs" class="mw-redirect" title="Lungs">lungs</a>, <a href="/wiki/Skin" title="Skin">skin</a>, or <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a>.<sup id="cite_ref-NIH2013What_2-4" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Less commonly affected are the eyes, <a href="/wiki/Liver" title="Liver">liver</a>, heart, and <a href="/wiki/Human_brain" title="Human brain">brain</a>, though any <a href="/wiki/Organ_(anatomy)" class="mw-redirect" title="Organ (anatomy)">organ</a> can be affected.<sup id="cite_ref-NIH2013What_2-5" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The signs and symptoms depend on the organ involved.<sup id="cite_ref-NIH2013What_2-6" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Often, no symptoms or only mild symptoms are seen.<sup id="cite_ref-NIH2013What_2-7" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> When it affects the lungs, <a href="/wiki/Wheezing" class="mw-redirect" title="Wheezing">wheezing</a>, coughing, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>, or chest pain may occur.<sup id="cite_ref-NIH2013Sym_3-3" class="reference"><a href="#cite_note-NIH2013Sym-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Some may have <a href="/wiki/L%C3%B6fgren_syndrome" title="Löfgren syndrome">Löfgren syndrome</a> with fever, <a href="/wiki/Bilateral_hilar_lymphadenopathy" title="Bilateral hilar lymphadenopathy">enlarged hilar lymph nodes</a>, <a href="/wiki/Arthritis" title="Arthritis">arthritis</a>, and a rash known as <a href="/wiki/Erythema_nodosum" title="Erythema nodosum">erythema nodosum</a>.<sup id="cite_ref-NIH2013What_2-8" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>The cause of sarcoidosis is unknown.<sup id="cite_ref-NIH2013What_2-9" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Some believe it may be due to an immune reaction to a trigger such as an <a href="/wiki/Infection" title="Infection">infection</a> or chemicals in those who are genetically predisposed.<sup id="cite_ref-Bau2011_12-0" class="reference"><a href="#cite_note-Bau2011-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Those with affected family members are at greater risk.<sup id="cite_ref-NIH2013Risk_4-2" class="reference"><a href="#cite_note-NIH2013Risk-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Diagnosis is partly based on signs and symptoms, which may be supported by <a href="/wiki/Tissue_biopsy" class="mw-redirect" title="Tissue biopsy">biopsy</a>.<sup id="cite_ref-Gov2015_6-1" class="reference"><a href="#cite_note-Gov2015-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Findings that make it likely include <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">large lymph nodes</a> at the <a href="/wiki/Root_of_the_lung" title="Root of the lung">root of the lung</a> on both sides, <a href="/wiki/Hypercalcaemia" title="Hypercalcaemia">high blood calcium</a> with a normal <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">parathyroid hormone</a> level, or elevated levels of <a href="/wiki/Angiotensin-converting_enzyme" title="Angiotensin-converting enzyme">angiotensin-converting enzyme</a> in the blood.<sup id="cite_ref-Gov2015_6-2" class="reference"><a href="#cite_note-Gov2015-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The diagnosis should be made only after excluding other possible causes of similar symptoms such as <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>.<sup id="cite_ref-Gov2015_6-3" class="reference"><a href="#cite_note-Gov2015-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Sarcoidosis may resolve without any treatment within a few years.<sup id="cite_ref-NIH2013What_2-10" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Wj2015_5-2" class="reference"><a href="#cite_note-Wj2015-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> However, some people may have long-term or severe disease.<sup id="cite_ref-Wj2015_5-3" class="reference"><a href="#cite_note-Wj2015-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Some symptoms may be improved with the use of anti-inflammatory drugs such as <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a>.<sup id="cite_ref-Dr2014_8-1" class="reference"><a href="#cite_note-Dr2014-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> In cases where the condition causes significant health problems, steroids such as <a href="/wiki/Prednisone" title="Prednisone">prednisone</a> are indicated.<sup id="cite_ref-Jud2016_9-1" class="reference"><a href="#cite_note-Jud2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Medications such as <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, <a href="/wiki/Chloroquine" title="Chloroquine">chloroquine</a>, or <a href="/wiki/Azathioprine" title="Azathioprine">azathioprine</a> may occasionally be used in an effort to decrease the side effects of steroids.<sup id="cite_ref-Jud2016_9-2" class="reference"><a href="#cite_note-Jud2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The risk of death is 1–7%.<sup id="cite_ref-Wj2015_5-4" class="reference"><a href="#cite_note-Wj2015-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The chance of the disease returning in someone who has had it previously is less than 5%.<sup id="cite_ref-NIH2013What_2-11" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>In 2015, pulmonary sarcoidosis and <a href="/wiki/Interstitial_lung_disease" title="Interstitial lung disease">interstitial lung disease</a> affected 1.9 million people globally and they resulted in 122,000 deaths.<sup id="cite_ref-GBD2015Pre_10-1" class="reference"><a href="#cite_note-GBD2015Pre-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-GBD2015De_11-1" class="reference"><a href="#cite_note-GBD2015De-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> It is most common in Scandinavians, but occurs in all parts of the world.<sup id="cite_ref-Kob2015_14-0" class="reference"><a href="#cite_note-Kob2015-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> In the United States, risk is greater among black people as opposed to white people.<sup id="cite_ref-Kob2015_14-1" class="reference"><a href="#cite_note-Kob2015-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> It usually begins between the ages of 20 and 50.<sup id="cite_ref-NIH2013Risk_4-3" class="reference"><a href="#cite_note-NIH2013Risk-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It occurs more often in women than men.<sup id="cite_ref-NIH2013Risk_4-4" class="reference"><a href="#cite_note-NIH2013Risk-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Sarcoidosis was first described in 1877 by the English doctor <a href="/wiki/Jonathan_Hutchinson" title="Jonathan Hutchinson">Jonathan Hutchinson</a> as a non-painful skin disease.<sup id="cite_ref-hutch_15-0" class="reference"><a href="#cite_note-hutch-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Sarcoidosis_signs_and_symptoms.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Sarcoidosis_signs_and_symptoms.png/290px-Sarcoidosis_signs_and_symptoms.png" decoding="async" width="290" height="502" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/2/20/Sarcoidosis_signs_and_symptoms.png 1.5x" data-file-width="367" data-file-height="635" /></a><figcaption>Signs and symptoms of sarcoidosis<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Cutaneous_findings_in_systemic_sarcoidosis.JPEG" class="mw-file-description"><img alt="Multiple reddish-brownish papules and plaques on the left mandibular region of an adult face" src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Cutaneous_findings_in_systemic_sarcoidosis.JPEG/290px-Cutaneous_findings_in_systemic_sarcoidosis.JPEG" decoding="async" width="290" height="190" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Cutaneous_findings_in_systemic_sarcoidosis.JPEG/435px-Cutaneous_findings_in_systemic_sarcoidosis.JPEG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Cutaneous_findings_in_systemic_sarcoidosis.JPEG/580px-Cutaneous_findings_in_systemic_sarcoidosis.JPEG 2x" data-file-width="1799" data-file-height="1181" /></a><figcaption>Sarcoid affecting the skin</figcaption></figure> <p>Sarcoidosis is a systemic inflammatory disease that can affect any organ, although it can be <a href="/wiki/Asymptomatic" title="Asymptomatic">asymptomatic</a> and is discovered by accident in about 5% of cases.<sup id="cite_ref-MSRP_17-0" class="reference"><a href="#cite_note-MSRP-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Common symptoms, which tend to be <a href="/wiki/Non-specific_symptoms" class="mw-redirect" title="Non-specific symptoms">vague</a>, include <a href="/wiki/Fatigue_(physical)" class="mw-redirect" title="Fatigue (physical)">fatigue</a> (unrelieved by sleep; occurs in up to 85% of cases<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup>), <a href="/wiki/Asthenia" class="mw-redirect" title="Asthenia">lack of energy</a>, <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a>, joint aches and pains (which occur in about 70% of cases),<sup id="cite_ref-nunes_19-0" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Arthritis" title="Arthritis">arthritis</a> (14–38% of cases), <a href="/wiki/Xerophthalmia" title="Xerophthalmia">dry eyes</a>, swelling of the knees, blurry vision, <a href="/wiki/Dyspnea" class="mw-redirect" title="Dyspnea">shortness of breath</a>, a dry, hacking cough, or skin lesions.<sup id="cite_ref-Merck_20-0" class="reference"><a href="#cite_note-Merck-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-dis2009_22-0" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Dempsey_b3206_23-0" class="reference"><a href="#cite_note-Dempsey_b3206-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Less commonly, people may cough up blood.<sup id="cite_ref-Merck_20-1" class="reference"><a href="#cite_note-Merck-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Sarcoidosis is also accompanied by psychological distress and symptoms of anxiety and depression, which are also associated with fatigue.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> The cutaneous symptoms vary, and range from <a href="/wiki/Rash" title="Rash">rashes</a> and noduli (small bumps) to <a href="/wiki/Erythema_nodosum" title="Erythema nodosum">erythema nodosum</a>, granuloma annulare, or <a href="/wiki/Lupus_pernio" title="Lupus pernio">lupus pernio</a>. Sarcoidosis and cancer may mimic one another, making the <a href="/wiki/Differential_diagnosis" title="Differential diagnosis">distinction</a> difficult.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>The combination of <a href="/wiki/Erythema_nodosum" title="Erythema nodosum">erythema nodosum</a>, <a href="/wiki/Bilateral_hilar_lymphadenopathy" title="Bilateral hilar lymphadenopathy">bilateral hilar lymphadenopathy</a>, and <a href="/wiki/Arthralgia" title="Arthralgia">joint pain</a> is called <a href="/wiki/L%C3%B6fgren_syndrome" title="Löfgren syndrome">Löfgren syndrome</a>, which has a relatively good prognosis.<sup id="cite_ref-Merck_20-2" class="reference"><a href="#cite_note-Merck-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> This form of the disease occurs significantly more often in Scandinavian patients than in those of non-Scandinavian origin.<sup id="cite_ref-MSR_26-0" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Respiratory_tract">Respiratory tract</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=2" title="Edit section: Respiratory tract"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Localization to the lungs is by far the most common manifestation of sarcoidosis.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> At least 90% of those affected experience lung involvement.<sup id="cite_ref-Harrison_28-0" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Overall, about 50% develop permanent pulmonary abnormalities, and 5 to 15% have progressive fibrosis of the lung <a href="/wiki/Parenchyma" title="Parenchyma">parenchyma</a>. Sarcoidosis of the lung is primarily an <a href="/wiki/Interstitial_lung_disease" title="Interstitial lung disease">interstitial lung disease</a> in which the inflammatory process involves the alveoli, small bronchi, and small blood vessels.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> In acute and subacute cases, physical examination usually reveals dry <a href="/wiki/Crackles" title="Crackles">crackles</a>.<sup id="cite_ref-Harrison_28-1" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> At least 5% of cases include <a href="/wiki/Pulmonary_arterial_hypertension" title="Pulmonary arterial hypertension">pulmonary arterial hypertension</a>.<sup id="cite_ref-Harrison_28-2" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> The upper respiratory tract (including the <a href="/wiki/Larynx" title="Larynx">larynx</a>, <a href="/wiki/Pharynx" title="Pharynx">pharynx</a>, and <a href="/wiki/Sinuses" class="mw-redirect" title="Sinuses">sinuses</a>) may be affected, which occurs in between 5 and 10% of cases.<sup id="cite_ref-nat2011_31-0" class="reference"><a href="#cite_note-nat2011-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p>The four stages of pulmonary involvement are based on radiological stage of the disease, which is helpful in prognosis:<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Stage I: <a href="/wiki/Bilateral_hilar_lymphadenopathy" title="Bilateral hilar lymphadenopathy">bilateral hilar lymphadenopathy</a> (BHL) alone</li> <li>Stage II: BHL with <a href="/wiki/Pulmonary_infiltrate" title="Pulmonary infiltrate">pulmonary infiltrates</a></li> <li>Stage III: pulmonary infiltrates without BHL</li> <li>Stage IV: fibrosis</li></ul> <p>Use of the Scadding scale only provides general information regarding the prognosis of the pulmonary disease over time. Caution is recommended, as it only shows a general relation with physiological markers of the disease and the variation is such that it has limited applicability in individual assessments, including treatment decisions.<sup id="cite_ref-Bau2011_12-1" class="reference"><a href="#cite_note-Bau2011-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Skin">Skin</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=3" title="Edit section: Skin"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Skin_manifestations_of_sarcoidosis" title="Skin manifestations of sarcoidosis">Skin manifestations of sarcoidosis</a></div> <p>Sarcoidosis involves the skin in between 9 and 37% of cases and is more common in <a href="/wiki/African_Americans" title="African Americans">African Americans</a> than in European Americans.<sup id="cite_ref-Harrison_28-3" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> The skin is the second-most commonly affected organ after the lungs.<sup id="cite_ref-cut2012_33-0" class="reference"><a href="#cite_note-cut2012-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> The most common lesions are erythema nodosum, plaques, <a href="/wiki/Maculopapular" class="mw-redirect" title="Maculopapular">maculopapular</a> eruptions, subcutaneous nodules, and <a href="/wiki/Lupus_pernio" title="Lupus pernio">lupus pernio</a>.<sup id="cite_ref-cut2012_33-1" class="reference"><a href="#cite_note-cut2012-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Treatment is not required, since the lesions usually resolve spontaneously in 2–4 weeks. Although it may be disfiguring, cutaneous sarcoidosis rarely causes major problems.<sup id="cite_ref-Harrison_28-4" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Sarcoidosis of the scalp presents with diffuse or patchy hair loss.<sup id="cite_ref-Andrews_36-0" class="reference"><a href="#cite_note-Andrews-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Heart">Heart</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=4" title="Edit section: Heart"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Histologically, sarcoidosis of the heart is an active granulomatous inflammation surrounded by reactive oedema. The distribution of affected areas is patchy with localised enlargement of heart muscles. This causes scarring and remodelling of the heart, which leads to dilatation of heart cavities and thinning of heart muscles. As the situation progresses, it leads to <a href="/wiki/Aneurysm" title="Aneurysm">aneurysm</a> of heart chambers. When the distribution is diffuse, there would be dilatation of both ventricles of the heart, causing heart failure and arrhythmia. When the conduction system in the intraventricular septum is affected, it would lead to heart block, <a href="/wiki/Ventricular_tachycardia" title="Ventricular tachycardia">ventricular tachycardia</a> and <a href="/wiki/Ventricular_arrhythmia" class="mw-redirect" title="Ventricular arrhythmia">ventricular arrhythmia</a>, causing <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">sudden death</a>. Nevertheless, the involvement of <a href="/wiki/Pericardium" title="Pericardium">pericardium</a> and heart valves are uncommon.<sup id="cite_ref-Yatsynovich_2018_38-0" class="reference"><a href="#cite_note-Yatsynovich_2018-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p><p>The frequency of cardiac involvement varies and is significantly influenced by race; in Japan, more than 25% of those with sarcoidosis have symptomatic cardiac involvement, whereas in the US and Europe, only about 5% of cases present with cardiac involvement.<sup id="cite_ref-Harrison_28-5" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Autopsy studies in the US have revealed a frequency of cardiac involvement of about 20–30%, whereas autopsy studies in Japan have shown a frequency of 60%.<sup id="cite_ref-dis2009_22-1" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The presentation of cardiac sarcoidosis can range from asymptomatic conduction abnormalities to fatal ventricular arrhythmia.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid16415205_40-0" class="reference"><a href="#cite_note-pmid16415205-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>Conduction abnormalities are the most common cardiac manifestations of sarcoidosis in humans and can include complete <a href="/wiki/Heart_block" title="Heart block">heart block</a>.<sup id="cite_ref-heart_41-0" class="reference"><a href="#cite_note-heart-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Second to conduction abnormalities, in frequency, are ventricular arrhythmias, which occurs in about 23% of cases with cardiac involvement.<sup id="cite_ref-heart_41-1" class="reference"><a href="#cite_note-heart-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Sudden cardiac death, either due to ventricular arrhythmias or complete heart block is a rare complication of cardiac sarcoidosis.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Rajasenan-1969_43-0" class="reference"><a href="#cite_note-Rajasenan-1969-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Cardiac sarcoidosis can cause fibrosis, granuloma formation, or the accumulation of fluid in the interstitium of the heart, or a combination of the former two.<sup id="cite_ref-pmid22608949_44-0" class="reference"><a href="#cite_note-pmid22608949-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Cardiac sarcoidosis may also cause <a href="/wiki/Congestive_heart_failure" class="mw-redirect" title="Congestive heart failure">congestive heart failure</a> when granulomas cause myocardial fibrosis and scarring.<sup id="cite_ref-stanford_46-0" class="reference"><a href="#cite_note-stanford-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Congestive heart failure affects 25-75% of those with cardiac sarcoidosis. <a href="/wiki/Diabetes" title="Diabetes">Diabetes mellitus</a> and sarcoidosis-related arrhythmias are believed to be strong risk factors of heart failure in sarcoidosis.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> A small (20-40%) increased risk of <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">acute myocardial infarction</a> has also been described.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Pulmonary arterial hypertension occurs by two mechanisms in cardiac sarcoidosis: reduced left heart function due to granulomas weakening the heart muscle or from impaired blood flow.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Eye">Eye</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=5" title="Edit section: Eye"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Eye involvement occurs in about 10–90% of cases.<sup id="cite_ref-dis2009_22-2" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Manifestations in the eye include <a href="/wiki/Uveitis" title="Uveitis">uveitis</a>, <a href="/wiki/Uveoparotitis" title="Uveoparotitis">uveoparotitis</a>, and retinal inflammation, which may result in loss of visual acuity or blindness.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> The most common ophthalmologic manifestation of sarcoidosis is <a href="/wiki/Uveitis" title="Uveitis">uveitis</a>.<sup id="cite_ref-dis2009_22-3" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> The combination of anterior uveitis, <a href="/wiki/Parotitis" title="Parotitis">parotitis</a>, VII cranial nerve paralysis and fever is called uveoparotid fever or <a href="/wiki/Heerfordt_syndrome" title="Heerfordt syndrome">Heerfordt syndrome</a> (<a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/D86.8">D86.8</a>). Development of scleral nodule associated with sarcoidosis has been observed.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Nervous_system">Nervous system</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=6" title="Edit section: Nervous system"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Neurosarcoidosis" title="Neurosarcoidosis">Neurosarcoidosis</a></div> <p>Any of the components of the nervous system can be involved.<sup id="cite_ref-neuro2012_54-0" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> Sarcoidosis affecting the nervous system is known as <a href="/wiki/Neurosarcoidosis" title="Neurosarcoidosis">neurosarcoidosis</a>.<sup id="cite_ref-neuro2012_54-1" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> Cranial nerves are most commonly affected, accounting for about 5–30% of neurosarcoidosis cases, and peripheral facial nerve palsy, often bilateral, is the most common neurological manifestation of sarcoidosis.<sup id="cite_ref-neuro2012_54-2" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-extra2012_56-0" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> It occurs suddenly and is usually transient. The central nervous system involvement is present in 10–25% of sarcoidosis cases.<sup id="cite_ref-nat2011_31-1" class="reference"><a href="#cite_note-nat2011-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Other common manifestations of neurosarcoidosis include optic nerve dysfunction, <a href="/wiki/Papilledema" title="Papilledema">papilledema</a>, palate dysfunction, neuroendocrine changes, hearing abnormalities, hypothalamic and pituitary abnormalities, chronic meningitis, and <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">peripheral neuropathy</a>.<sup id="cite_ref-Harrison_28-6" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Myelopathy" title="Myelopathy">Myelopathy</a>, that is spinal cord involvement, occurs in about 16–43% of neurosarcoidosis cases and is often associated with the poorest prognosis of the neurosarcoidosis subtypes.<sup id="cite_ref-neuro2012_54-3" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> Whereas facial nerve palsies and acute meningitis due to sarcoidosis tend to have the most favourable prognosis,<sup id="cite_ref-neuro2012_54-4" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> another common finding in sarcoidosis with neurological involvement is autonomic or sensory small-fiber neuropathy.<sup id="cite_ref-pmid21298560_57-0" class="reference"><a href="#cite_note-pmid21298560-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> Neuroendocrine sarcoidosis accounts for about 5–10% of neurosarcoidosis cases and can lead to <a href="/wiki/Diabetes_insipidus" title="Diabetes insipidus">diabetes insipidus</a>, changes in menstrual cycle and hypothalamic dysfunction.<sup id="cite_ref-neuro2012_54-5" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-extra2012_56-1" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> The latter can lead to changes in body temperature, mood, and prolactin (see the endocrine and exocrine section for details).<sup id="cite_ref-neuro2012_54-6" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Endocrine_and_exocrine">Endocrine and exocrine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=7" title="Edit section: Endocrine and exocrine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Prolactin" title="Prolactin">Prolactin</a> is frequently increased in sarcoidosis, between 3 and 32% of cases have <a href="/wiki/Hyperprolactinemia" class="mw-redirect" title="Hyperprolactinemia">hyperprolactinemia</a><sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> this frequently leads to <a href="/wiki/Amenorrhea" title="Amenorrhea">amenorrhea</a>, <a href="/wiki/Galactorrhea" title="Galactorrhea">galactorrhea</a>, or <a href="/wiki/Nonpuerperal_mastitis" title="Nonpuerperal mastitis">nonpuerperal mastitis</a> in women. It also frequently causes an increase in 1,25-dihydroxy vitamin D, the active metabolite of <a href="/wiki/Vitamin_D" title="Vitamin D">vitamin D</a>, which is usually hydroxylated within the kidney, but in sarcoidosis patients, hydroxylation of vitamin D can occur outside the kidneys, namely inside the immune cells found in the granulomas the condition produces. 1,25-dihydroxy vitamin D is the main cause for hypercalcemia in sarcoidosis and is overproduced by sarcoid granulomata. Gamma-interferon produced by activated lymphocytes and macrophages plays a major role in the synthesis of 1 alpha, 25(OH)2D3.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> Hypercalciuria (excessive secretion of calcium in one's urine) and <a href="/wiki/Hypercalcemia" class="mw-redirect" title="Hypercalcemia">hypercalcemia</a> (an excessively high amount of calcium in the blood) are seen in <10% of individuals and likely results from the increased 1,25-dihydroxy vitamin D production.<sup id="cite_ref-Cush-163_61-0" class="reference"><a href="#cite_note-Cush-163-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p><p>Thyroid dysfunction is seen in 4.2–4.6% of cases.<sup id="cite_ref-Antonelli_2006_16899854_62-0" class="reference"><a href="#cite_note-Antonelli_2006_16899854-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Parotid" class="mw-redirect" title="Parotid">Parotid</a> enlargement occurs in about 5–10% of cases.<sup id="cite_ref-nunes_19-1" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Bilateral involvement is the rule. The gland is usually not tender, but firm and smooth. <a href="/wiki/Xerostomia" title="Xerostomia">Dry mouth</a> can occur; other exocrine glands are affected only rarely.<sup id="cite_ref-Harrison_28-7" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> The eyes, their glands, or the parotid glands are affected in 20–50% of cases.<sup id="cite_ref-Path_64-0" class="reference"><a href="#cite_note-Path-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Gastrointestinal_and_genitourinary">Gastrointestinal and genitourinary</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=8" title="Edit section: Gastrointestinal and genitourinary"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Symptomatic gastrointestinal (GI) involvement occurs in less than 1% of cases (if one excludes the liver), and most commonly the stomach is affected, although the small or large intestine may also be affected in a small portion of cases.<sup id="cite_ref-nunes_19-2" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> Studies at autopsy have revealed GI involvement in less than 10% of people.<sup id="cite_ref-extra2012_56-2" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> These cases would likely mimic <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>, which is a more commonly intestine-affecting granulomatous disease.<sup id="cite_ref-nunes_19-3" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> About 1–3% of people have evidence of pancreatic involvement at autopsy.<sup id="cite_ref-extra2012_56-3" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Symptomatic kidney involvement occurs in just 0.7% of cases, although evidence of kidney involvement at autopsy has been reported in up to 22% of people and occurs exclusively in cases of chronic disease.<sup id="cite_ref-nunes_19-4" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-dis2009_22-4" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-extra2012_56-4" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Symptomatic kidney involvement is usually <a href="/wiki/Nephrocalcinosis" title="Nephrocalcinosis">nephrocalcinosis</a>, although granulomatous interstitial nephritis that presents with reduced <a href="/wiki/Creatinine" title="Creatinine">creatinine</a> clearance and little <a href="/wiki/Proteinuria" title="Proteinuria">proteinuria</a> is a close second.<sup id="cite_ref-nunes_19-5" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-extra2012_56-5" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Less commonly, the <a href="/wiki/Epididymis" title="Epididymis">epididymis</a>, <a href="/wiki/Testicles" class="mw-redirect" title="Testicles">testicles</a>, <a href="/wiki/Prostate" title="Prostate">prostate</a>, <a href="/wiki/Ovaries" class="mw-redirect" title="Ovaries">ovaries</a>, <a href="/wiki/Fallopian_tubes" class="mw-redirect" title="Fallopian tubes">fallopian tubes</a>, <a href="/wiki/Uterus" title="Uterus">uterus</a>, or the <a href="/wiki/Vulva" title="Vulva">vulva</a> may be affected, the latter may cause vulva itchiness.<sup id="cite_ref-dis2009_22-5" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Paknejad_269–27_67-0" class="reference"><a href="#cite_note-Paknejad_269–27-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Testicular_sarcoidosis" title="Testicular sarcoidosis">Testicular involvement</a> has been reported in about 5% of people at autopsy.<sup id="cite_ref-extra2012_56-6" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Paknejad_269–27_67-1" class="reference"><a href="#cite_note-Paknejad_269–27-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> In males, sarcoidosis may lead to infertility.<sup id="cite_ref-Paknejad_269–27_67-2" class="reference"><a href="#cite_note-Paknejad_269–27-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p><p>Around 70% of people have granulomas in their livers, although only in about 20–30% of cases, liver function test anomalies reflecting this fact are seen.<sup id="cite_ref-Merck_20-3" class="reference"><a href="#cite_note-Merck-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Harrison_28-8" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> About 5–15% of patients exhibit <a href="/wiki/Hepatomegaly" title="Hepatomegaly">hepatomegaly</a>.<sup id="cite_ref-dis2009_22-6" class="reference"><a href="#cite_note-dis2009-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Only 5–30% of cases of liver involvement are symptomatic.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> Usually, these changes reflect a <a href="/wiki/Cholestatic" class="mw-redirect" title="Cholestatic">cholestatic</a> pattern and include raised levels of <a href="/wiki/Alkaline_phosphatase" title="Alkaline phosphatase">alkaline phosphatase</a> (which is the most common liver function test anomaly seen in those with sarcoidosis), while <a href="/wiki/Bilirubin" title="Bilirubin">bilirubin</a> and <a href="/wiki/Aminotransferases" class="mw-redirect" title="Aminotransferases">aminotransferases</a> are only mildly elevated. Jaundice is rare.<sup id="cite_ref-nunes_19-6" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Harrison_28-9" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Blood">Blood</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=9" title="Edit section: Blood"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Abnormal blood tests are frequent, accounting for over 50% of cases, but are not diagnostic.<sup id="cite_ref-Harrison_28-10" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-nat2011_31-2" class="reference"><a href="#cite_note-nat2011-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Lymphopenia" class="mw-redirect" title="Lymphopenia">Lymphopenia</a> is the most common blood anomaly in sarcoidosis.<sup id="cite_ref-Harrison_28-11" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Anemia" title="Anemia">Anemia</a> occurs in about 20% of people with sarcoidosis.<sup id="cite_ref-Harrison_28-12" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Leukopenia" title="Leukopenia">Leukopenia</a> is less common and occurs in even fewer cases but is rarely severe.<sup id="cite_ref-Harrison_28-13" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Thrombocytopenia" title="Thrombocytopenia">Thrombocytopenia</a> and <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemia</a> are fairly rare.<sup id="cite_ref-nunes_19-7" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> In the absence of <a href="/wiki/Splenomegaly" title="Splenomegaly">splenomegaly</a>, <a href="/wiki/Leukopenia" title="Leukopenia">leukopenia</a> may reflect bone marrow involvement, but the most common mechanism is a redistribution of blood T cells to sites of disease.<sup id="cite_ref-AJR1999_69-0" class="reference"><a href="#cite_note-AJR1999-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> Other nonspecific findings include <a href="/wiki/Monocytosis" title="Monocytosis">monocytosis</a>, occurring in the majority of sarcoidosis cases,<sup id="cite_ref-MonocyteSarcoid_70-0" class="reference"><a href="#cite_note-MonocyteSarcoid-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> increased hepatic enzymes or <a href="/wiki/Alkaline_phosphatase" title="Alkaline phosphatase">alkaline phosphatase</a>. People with sarcoidosis often have immunologic anomalies like allergies to test antigens such as <i><a href="/wiki/Candida_(fungus)" title="Candida (fungus)">Candida</a></i> or <a href="/wiki/Purified_protein_derivative" class="mw-redirect" title="Purified protein derivative">purified protein derivative</a>.<sup id="cite_ref-Path_64-1" class="reference"><a href="#cite_note-Path-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> Polyclonal <a href="/wiki/Hypergammaglobulinemia" title="Hypergammaglobulinemia">hypergammaglobulinemia</a> is also a fairly common immunologic anomaly seen in sarcoidosis.<sup id="cite_ref-Path_64-2" class="reference"><a href="#cite_note-Path-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">Lymphadenopathy</a> (swollen glands) is common in sarcoidosis and occurs in 15% of cases.<sup id="cite_ref-Dempsey_b3206_23-1" class="reference"><a href="#cite_note-Dempsey_b3206-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Intrathoracic nodes are enlarged in 75 to 90% of all people; usually this involves the hilar nodes, but the paratracheal nodes are commonly involved. Peripheral lymphadenopathy is very common, particularly involving the <a href="/wiki/Cervical_lymph_nodes" title="Cervical lymph nodes">cervical</a> (the most common head and neck manifestation of the disease), axillary, epitrochlear, and inguinal nodes.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> Approximately 75% of cases show microscopic involvement of the spleen, although only in about 5–10% of cases does <a href="/wiki/Splenomegaly" title="Splenomegaly">splenomegaly</a> appear.<sup id="cite_ref-nunes_19-8" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Path_64-3" class="reference"><a href="#cite_note-Path-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Bone,_joints,_and_muscles"><span id="Bone.2C_joints.2C_and_muscles"></span>Bone, joints, and muscles</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=10" title="Edit section: Bone, joints, and muscles"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Sarcoidosis can be involved with the joints, bones, and muscles. This causes a wide variety of musculoskeletal complaints that act through different mechanisms.<sup id="cite_ref-Dellaripa_2013_72-0" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> About 5–15% of cases affect the bones, joints, or muscles.<sup id="cite_ref-nat2011_31-3" class="reference"><a href="#cite_note-nat2011-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p>Arthritic syndromes can be categorized as acute or chronic.<sup id="cite_ref-Dellaripa_2013_72-1" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Sarcoidosis patients with acute arthritis often also have bilateral <a href="/wiki/Hilar_lymphadenopathy" class="mw-redirect" title="Hilar lymphadenopathy">hilar lymphadenopathy</a> and erythema nodosum. These three associated syndromes often occur together in Löfgren syndrome.<sup id="cite_ref-Dellaripa_2013_72-2" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> The arthritis symptoms of Löfgren syndrome occur most frequently in the ankles, followed by the knees, wrists, elbows, and metacarpophalangeal joints.<sup id="cite_ref-Dellaripa_2013_72-3" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Usually, true arthritis is not present, but instead, periarthritis appears as a swelling in the soft tissue around the joints that can be seen by ultrasonographic methods.<sup id="cite_ref-Dellaripa_2013_72-4" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> These joint symptoms tend to precede or occur at the same time as erythema nodosum develops.<sup id="cite_ref-Dellaripa_2013_72-5" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Even when erythema nodosum is absent, it is believed that the combination of hilar lymphadenopathy and ankle periarthritis can be considered as a variant of Löfgren syndrome.<sup id="cite_ref-Dellaripa_2013_72-6" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Enthesitis" title="Enthesitis">Enthesitis</a> also occurs in about one-third of patients with acute sarcoid arthritis, mainly affecting the Achilles tendon and heels.<sup id="cite_ref-Dellaripa_2013_72-7" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Soft-tissue swelling of the ankles can be prominent, and biopsy of this soft tissue reveals no granulomas, but does show <a href="/wiki/Panniculitis" title="Panniculitis">panniculitis</a> similar to erythema nodosum.<sup id="cite_ref-Dellaripa_2013_72-8" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> </p><p>Chronic sarcoid arthritis usually occurs in the setting of more diffuse organ involvement.<sup id="cite_ref-Dellaripa_2013_72-9" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> The ankles, knees, wrists, elbows, and hands may all be affected in the chronic form and often this presents itself in a polyarticular pattern.<sup id="cite_ref-Dellaripa_2013_72-10" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Dactylitis" title="Dactylitis">Dactylitis</a> similar to that seen in <a href="/wiki/Psoriatic_arthritis" title="Psoriatic arthritis">psoriatic arthritis</a>, that is associated with pain, swelling, overlying skin erythema, and underlying bony changes may also occur.<sup id="cite_ref-Dellaripa_2013_72-11" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Development of <a href="/wiki/Jaccoud_arthropathy" title="Jaccoud arthropathy">Jaccoud arthropathy</a> (a nonerosive deformity) is very rarely seen.<sup id="cite_ref-Dellaripa_2013_72-12" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> </p><p>Bone involvement in sarcoidosis has been reported in 1–13% of cases.<sup id="cite_ref-extra2012_56-7" class="reference"><a href="#cite_note-extra2012-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> The most frequent sites of involvement are the hands and feet, whereas the spine is less commonly affected.<sup id="cite_ref-Dellaripa_2013_72-13" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Half of the patients with bony lesions experience pain and stiffness, whereas the other half remain asymptomatic.<sup id="cite_ref-Dellaripa_2013_72-14" class="reference"><a href="#cite_note-Dellaripa_2013-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Periostitis" title="Periostitis">Periostitis</a> is rarely seen in sarcoidosis and has been found to present itself at the femoral bone.<sup id="cite_ref-Shimamura_2015_73-0" class="reference"><a href="#cite_note-Shimamura_2015-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Korkmaz_1999_74-0" class="reference"><a href="#cite_note-Korkmaz_1999-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=11" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The exact cause of sarcoidosis is not known.<sup id="cite_ref-NIH2013What_2-12" class="reference"><a href="#cite_note-NIH2013What-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The current working hypothesis is, in genetically susceptible individuals, sarcoidosis is caused through alteration to the immune response after exposure to an environmental, occupational, or infectious agent.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> Some cases may be caused by treatment with <a href="/wiki/Tumor_necrosis_factor" title="Tumor necrosis factor">tumor necrosis factor</a> (TNF) inhibitors like <a href="/wiki/Etanercept" title="Etanercept">etanercept</a>.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Genetics">Genetics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=12" title="Edit section: Genetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The heritability of sarcoidosis varies according to <a href="/wiki/Ethnic_group" class="mw-redirect" title="Ethnic group">ethnicity</a>. About 20% of <a href="/wiki/African_American" class="mw-redirect" title="African American">African Americans</a> with sarcoidosis have a family member with the condition, whereas the same figure for <a href="/wiki/European_Americans" title="European Americans">European Americans</a> is about 5%. Additionally, in African Americans, who seem to experience more severe and chronic disease, siblings and parents of sarcoidosis cases have about a 2.5-fold increased risk for developing the disease.<sup id="cite_ref-MSR_26-1" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> In Swedish individuals heritability was found to be 39%.<sup id="cite_ref-:1_77-0" class="reference"><a href="#cite_note-:1-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> In this group, if a first-degree family member was affected, a person has a four-fold greater risk of being affected.<sup id="cite_ref-:1_77-1" class="reference"><a href="#cite_note-:1-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> </p><p>Investigations of genetic susceptibility yielded many candidate genes, but only few were confirmed by further investigations and no reliable genetic markers are known. Currently, the most interesting candidate gene is <i><a href="/wiki/BTNL2" title="BTNL2">BTNL2</a></i>; several <i><a href="/wiki/HLA-DR" title="HLA-DR">HLA-DR</a></i> risk alleles are also being investigated.<sup id="cite_ref-78" class="reference"><a href="#cite_note-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-79" class="reference"><a href="#cite_note-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> In persistent sarcoidosis, the HLA haplotype <i><a href="/wiki/HLA-B7" title="HLA-B7">HLA-B7</a>-<a href="/wiki/HLA-DR15" title="HLA-DR15">DR15</a></i> is either cooperating in disease or another gene between these two loci is associated. In nonpersistent disease, a strong genetic association exists with <i><a href="/wiki/HLA_DR3-DQ2" title="HLA DR3-DQ2">HLA DR3-DQ2</a></i>.<sup id="cite_ref-pmid14656748_80-0" class="reference"><a href="#cite_note-pmid14656748-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup> Cardiac sarcoid has been connected to <a href="/wiki/Tumor_necrosis_factor_alpha" class="mw-redirect" title="Tumor necrosis factor alpha">tumor necrosis factor alpha</a> (TNFA) variants.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Infectious_agents">Infectious agents</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=13" title="Edit section: Infectious agents"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Several infectious agents appear to be significantly associated with sarcoidosis, but none of the known associations is specific enough to suggest a direct causative role.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup> The major implicated infectious agents include: <a href="/wiki/Mycobacteria" class="mw-redirect" title="Mycobacteria">mycobacteria</a>, <a href="/wiki/Fungi" class="mw-redirect" title="Fungi">fungi</a>, <a href="/wiki/Borrelia" title="Borrelia">borrelia</a>, and <a href="/wiki/Rickettsia" title="Rickettsia">rickettsia</a>.<sup id="cite_ref-path2013_84-0" class="reference"><a href="#cite_note-path2013-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup> A meta-analysis investigating the role of mycobacteria in sarcoidosis found it was present in 26.4% of cases, but they also detected a possible <a href="/wiki/Publication_bias" title="Publication bias">publication bias</a>, so the results need further confirmation.<sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-86" class="reference"><a href="#cite_note-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup> <i><a href="/wiki/Mycobacterium_tuberculosis" title="Mycobacterium tuberculosis">Mycobacterium tuberculosis</a></i> <a href="/wiki/Catalase" title="Catalase">catalase</a>-<a href="/wiki/Peroxidase" title="Peroxidase">peroxidase</a> has been identified as a possible antigen catalyst of sarcoidosis.<sup id="cite_ref-87" class="reference"><a href="#cite_note-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup> The disease has also been reported by transmission via <a href="/wiki/Organ_transplant" class="mw-redirect" title="Organ transplant">organ transplants</a>.<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">[</span>88<span class="cite-bracket">]</span></a></sup> A large epidemiological study found little evidence that infectious diseases spanning years before sarcoidosis diagnosis could confer measurable risks for sarcoidosis diagnosis in the future.<sup id="cite_ref-89" class="reference"><a href="#cite_note-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Autoimmune">Autoimmune</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=14" title="Edit section: Autoimmune"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Association of <a href="/wiki/Autoimmune" class="mw-redirect" title="Autoimmune">autoimmune</a> disorders has been frequently observed. The exact mechanism of this relation is not known, but some evidence supports the hypothesis that this is a consequence of Th1 lymphokine prevalence.<sup id="cite_ref-Antonelli_2006_16899854_62-1" class="reference"><a href="#cite_note-Antonelli_2006_16899854-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Romagnani_1997_9190109_90-0" class="reference"><a href="#cite_note-Romagnani_1997_9190109-90"><span class="cite-bracket">[</span>90<span class="cite-bracket">]</span></a></sup> Tests of delayed cutaneous hypersensitivity have been used to measure progression.<sup id="cite_ref-pmid11948059_91-0" class="reference"><a href="#cite_note-pmid11948059-91"><span class="cite-bracket">[</span>91<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=15" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Granulomatous_inflammation" class="mw-redirect" title="Granulomatous inflammation">Granulomatous inflammation</a> is characterized primarily by the accumulation of <a href="/wiki/Macrophage" title="Macrophage">macrophages</a> and activated <a href="/wiki/T-lymphocytes" class="mw-redirect" title="T-lymphocytes">T-lymphocytes</a>, with increased production of key inflammatory mediators, <a href="/wiki/Tumor_necrosis_factor_alpha" class="mw-redirect" title="Tumor necrosis factor alpha">tumor necrosis factor alpha</a> (TNF), <a href="/wiki/Interferon_gamma" title="Interferon gamma">interferon gamma</a>, <a href="/wiki/Interleukin_2" title="Interleukin 2">interleukin 2</a> (IL-2), <a href="/wiki/Interleukin_8" title="Interleukin 8">IL-8</a>, <a href="/wiki/Interleukin_10" title="Interleukin 10">IL-10</a>, <a href="/wiki/Interleukin_12" title="Interleukin 12">IL-12</a>, <a href="/wiki/Interleukin_18" title="Interleukin 18">IL-18</a>, <a href="/wiki/Interleukin_23" title="Interleukin 23">IL-23</a> and <a href="/wiki/Transforming_growth_factor_beta" title="Transforming growth factor beta">transforming growth factor beta</a> (TGF-β), indicative of a <a href="/wiki/T_helper_cell" title="T helper cell">T helper cell</a>-mediated immune response.<sup id="cite_ref-path2013_84-1" class="reference"><a href="#cite_note-path2013-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-cyt_92-0" class="reference"><a href="#cite_note-cyt-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup> Sarcoidosis has paradoxical effects on inflammatory processes; it is characterized by increased macrophage and CD4 helper T-cell activation, resulting in accelerated inflammation, but immune response to antigen challenges such as tuberculin is suppressed. This paradoxic state of simultaneous hyper- and hypoactivity is suggestive of a state of <a href="/wiki/Anergy" class="mw-redirect" title="Anergy">anergy</a>. The anergy may also be responsible for the increased risk of infections and cancer.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2020)">citation needed</span></a></i>]</sup> The regulatory T-lymphocytes in the periphery of sarcoid granulomas appear to suppress IL-2 secretion, which is hypothesized to cause the state of anergy by preventing antigen-specific memory responses.<sup id="cite_ref-93" class="reference"><a href="#cite_note-93"><span class="cite-bracket">[</span>93<span class="cite-bracket">]</span></a></sup> </p><p>While TNF is widely believed to play an important role in the formation of granulomas (this is further supported by the finding that in animal models of mycobacterial granuloma formation inhibition of either TNF or IFN-γ production inhibits granuloma formation), sarcoidosis can and does still develop in those being treated with TNF antagonists like <a href="/wiki/Etanercept" title="Etanercept">etanercept</a>.<sup id="cite_ref-Verschueren_2007_17340045_94-0" class="reference"><a href="#cite_note-Verschueren_2007_17340045-94"><span class="cite-bracket">[</span>94<span class="cite-bracket">]</span></a></sup> B cells also likely play a role in the pathophysiology of sarcoidosis.<sup id="cite_ref-MSR_26-2" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Serum levels of soluble <a href="/wiki/Human_leukocyte_antigen" title="Human leukocyte antigen">human leukocyte antigen</a> (HLA) class I antigens and <a href="/wiki/Angiotensin_converting_enzyme" class="mw-redirect" title="Angiotensin converting enzyme">angiotensin converting enzyme</a> (ACE) are higher in people with sarcoidosis.<sup id="cite_ref-MSR_26-3" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Likewise the ratio of CD4/CD8 T cells in <a href="/wiki/Bronchoalveolar_lavage" title="Bronchoalveolar lavage">bronchoalveolar lavage</a> is usually higher in people with pulmonary sarcoidosis (usually >3.5), although it can be normal or even abnormally low in some cases.<sup id="cite_ref-MSR_26-4" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Serum ACE levels have been found to usually correlate with total granuloma load.<sup id="cite_ref-path2013_84-2" class="reference"><a href="#cite_note-path2013-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup> </p><p>Cases of sarcoidosis have also been reported as part of the <a href="/wiki/Immune_reconstitution_syndrome" class="mw-redirect" title="Immune reconstitution syndrome">immune reconstitution syndrome</a> of <a href="/wiki/HIV" title="HIV">HIV</a>, that is, when people receive treatment for HIV, their immune system rebounds and the result is that it starts to attack the antigens of opportunistic infections caught prior to said rebound and the resulting immune response starts to damage healthy tissue.<sup id="cite_ref-cyt_92-1" class="reference"><a href="#cite_note-cyt-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Histopathology">Histopathology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=16" title="Edit section: Histopathology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Sarcoidosis is characterized by the formation of non-necrotizing ("non-caseating") <a href="/wiki/Granuloma" title="Granuloma">granulomas</a> in various organs and tissues.<sup id="cite_ref-95" class="reference"><a href="#cite_note-95"><span class="cite-bracket">[</span>95<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Giant_cell" title="Giant cell">Giant cells</a>, specifically <a href="/wiki/Langhans_giant_cell" title="Langhans giant cell">Langhans giant cells</a>, are often seen in sarcoidosis.<sup id="cite_ref-96" class="reference"><a href="#cite_note-96"><span class="cite-bracket">[</span>96<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Schaumann_bodies" class="mw-redirect" title="Schaumann bodies">Schaumann bodies</a> seen in sarcoidosis are calcium and protein inclusions inside of giant cells as part of a granuloma.<sup id="cite_ref-GranLung_97-0" class="reference"><a href="#cite_note-GranLung-97"><span class="cite-bracket">[</span>97<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Asteroid_bodies" class="mw-redirect" title="Asteroid bodies">Asteroid bodies</a> can be seen in sarcoidosis.<sup id="cite_ref-GranLung_97-1" class="reference"><a href="#cite_note-GranLung-97"><span class="cite-bracket">[</span>97<span class="cite-bracket">]</span></a></sup> Hamazaki–Wesenberg bodies can be seen in lymph nodes and more rarely in lung biopsies with sarcoidosis and are inclusion bodies of <a href="/wiki/Lysosome" title="Lysosome">lysosomes</a> with protein, glycoprotein and iron.<sup id="cite_ref-98" class="reference"><a href="#cite_note-98"><span class="cite-bracket">[</span>98<span class="cite-bracket">]</span></a></sup> </p> <ul class="gallery mw-gallery-packed"> <li class="gallerybox" style="width: 294px"> <div class="thumb" style="width: 292px;"><span typeof="mw:File"><a href="/wiki/File:Sarcoidosis_(1)_lymph_node_biopsy.jpg" class="mw-file-description" title="Sarcoidosis in a lymph node"><img alt="Sarcoidosis in a lymph node" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/ca/Sarcoidosis_%281%29_lymph_node_biopsy.jpg/438px-Sarcoidosis_%281%29_lymph_node_biopsy.jpg" decoding="async" width="292" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/c/ca/Sarcoidosis_%281%29_lymph_node_biopsy.jpg 1.5x" data-file-width="600" data-file-height="452" /></a></span></div> <div class="gallerytext">Sarcoidosis in a lymph node</div> </li> <li class="gallerybox" style="width: 296.66666666667px"> <div class="thumb" style="width: 294.66666666667px;"><span typeof="mw:File"><a href="/wiki/File:Asteroid_body_intermed_mag.jpg" class="mw-file-description" title="Pulmonary sarcoidosis with granulomas with Langhans giant cells and asteroid bodies"><img alt="Pulmonary sarcoidosis with granulomas with Langhans giant cells and asteroid bodies" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/01/Asteroid_body_intermed_mag.jpg/442px-Asteroid_body_intermed_mag.jpg" decoding="async" width="295" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/01/Asteroid_body_intermed_mag.jpg/664px-Asteroid_body_intermed_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/01/Asteroid_body_intermed_mag.jpg/885px-Asteroid_body_intermed_mag.jpg 2x" data-file-width="3817" data-file-height="2848" /></a></span></div> <div class="gallerytext"><a href="/wiki/Pulmonary" class="mw-redirect" title="Pulmonary">Pulmonary</a> sarcoidosis with <a href="/wiki/Granuloma" title="Granuloma">granulomas</a> with <a href="/wiki/Langhans_giant_cell" title="Langhans giant cell">Langhans giant cells</a> and <a href="/wiki/Asteroid_bodies" class="mw-redirect" title="Asteroid bodies">asteroid bodies</a></div> </li> <li class="gallerybox" style="width: 288px"> <div class="thumb" style="width: 286px;"><span typeof="mw:File"><a href="/wiki/File:Sarcoidosis_-_Schaumann_body_2.jpg" class="mw-file-description" title="Schaumann body in sarcoidosis"><img alt="Schaumann body in sarcoidosis" src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7b/Sarcoidosis_-_Schaumann_body_2.jpg/429px-Sarcoidosis_-_Schaumann_body_2.jpg" decoding="async" width="286" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7b/Sarcoidosis_-_Schaumann_body_2.jpg/644px-Sarcoidosis_-_Schaumann_body_2.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7b/Sarcoidosis_-_Schaumann_body_2.jpg/859px-Sarcoidosis_-_Schaumann_body_2.jpg 2x" data-file-width="2103" data-file-height="1617" /></a></span></div> <div class="gallerytext"><a href="/wiki/Schaumann_body" title="Schaumann body">Schaumann body</a> in sarcoidosis</div> </li> <li class="gallerybox" style="width: 324.66666666667px"> <div class="thumb" style="width: 322.66666666667px;"><span typeof="mw:File"><a href="/wiki/File:Sarcoidosis_-_Asteroid_body_(6152059052).jpg" class="mw-file-description" title="Asteroid body in sarcoidosis"><img alt="Asteroid body in sarcoidosis" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Sarcoidosis_-_Asteroid_body_%286152059052%29.jpg/484px-Sarcoidosis_-_Asteroid_body_%286152059052%29.jpg" decoding="async" width="323" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Sarcoidosis_-_Asteroid_body_%286152059052%29.jpg/725px-Sarcoidosis_-_Asteroid_body_%286152059052%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Sarcoidosis_-_Asteroid_body_%286152059052%29.jpg/967px-Sarcoidosis_-_Asteroid_body_%286152059052%29.jpg 2x" data-file-width="2784" data-file-height="1901" /></a></span></div> <div class="gallerytext"><a href="/wiki/Asteroid_body" title="Asteroid body">Asteroid body</a> in sarcoidosis</div> </li> <li class="gallerybox" style="width: 324.66666666667px"> <div class="thumb" style="width: 322.66666666667px;"><span typeof="mw:File"><a href="/wiki/File:Sarcoidosis_-_Hamazaki-Wesenberg_(H-W)_bodies-_Lymph_node_(6134890353).jpg" class="mw-file-description" title="Hamazaki–Wesenberg bodies in sarcoidosis in lymph node"><img alt="Hamazaki–Wesenberg bodies in sarcoidosis in lymph node" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Sarcoidosis_-_Hamazaki-Wesenberg_%28H-W%29_bodies-_Lymph_node_%286134890353%29.jpg/484px-Sarcoidosis_-_Hamazaki-Wesenberg_%28H-W%29_bodies-_Lymph_node_%286134890353%29.jpg" decoding="async" width="323" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Sarcoidosis_-_Hamazaki-Wesenberg_%28H-W%29_bodies-_Lymph_node_%286134890353%29.jpg/725px-Sarcoidosis_-_Hamazaki-Wesenberg_%28H-W%29_bodies-_Lymph_node_%286134890353%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Sarcoidosis_-_Hamazaki-Wesenberg_%28H-W%29_bodies-_Lymph_node_%286134890353%29.jpg/967px-Sarcoidosis_-_Hamazaki-Wesenberg_%28H-W%29_bodies-_Lymph_node_%286134890353%29.jpg 2x" data-file-width="2784" data-file-height="1901" /></a></span></div> <div class="gallerytext">Hamazaki–Wesenberg bodies in sarcoidosis in lymph node</div> </li> </ul> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=17" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Sarkoidose1_CT_axial.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/88/Sarkoidose1_CT_axial.jpg/250px-Sarkoidose1_CT_axial.jpg" decoding="async" width="250" height="158" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/88/Sarkoidose1_CT_axial.jpg/375px-Sarkoidose1_CT_axial.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/88/Sarkoidose1_CT_axial.jpg/500px-Sarkoidose1_CT_axial.jpg 2x" data-file-width="1126" data-file-height="710" /></a><figcaption><a href="/wiki/Computed_tomography" class="mw-redirect" title="Computed tomography">CT scan</a> of the chest showing <a href="/wiki/Lymphadenopathy" title="Lymphadenopathy">lymphadenopathy</a> (arrows) in the <a href="/wiki/Mediastinum" title="Mediastinum">mediastinum</a> due to sarcoidosis</figcaption></figure> <p>Diagnosis of sarcoidosis is a <a href="/wiki/Diagnosis_of_exclusion" title="Diagnosis of exclusion">matter of exclusion</a>, as there is no specific test for the condition other than the Kveim-Siltzbach test. To exclude sarcoidosis in a case presenting with pulmonary symptoms might involve a <a href="/wiki/Chest_radiograph" title="Chest radiograph">chest radiograph</a>, <a href="/wiki/CT_scan" title="CT scan">CT scan</a> of chest, <a href="/wiki/PET_scan" class="mw-redirect" title="PET scan">PET scan</a>, CT-guided biopsy, mediastinoscopy, open lung biopsy, bronchoscopy with biopsy, endobronchial ultrasound, and <a href="/wiki/Endoscopic_ultrasound" title="Endoscopic ultrasound">endoscopic ultrasound</a> with <a href="/wiki/Fine-needle_aspiration" title="Fine-needle aspiration">fine-needle aspiration</a> of mediastinal <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a> (EBUS FNA). <a href="/wiki/Tissue_(biology)" title="Tissue (biology)">Tissue</a> from <a href="/wiki/Biopsy" title="Biopsy">biopsy</a> of lymph nodes is subjected to both <a href="/wiki/Flow_cytometry" title="Flow cytometry">flow cytometry</a> to rule out cancer and special stains (<a href="/wiki/Acid_fast" class="mw-redirect" title="Acid fast">acid fast</a> bacilli stain and <a href="/wiki/G%C3%B6m%C3%B6ri_methenamine_silver_stain" class="mw-redirect" title="Gömöri methenamine silver stain">Gömöri methenamine silver stain</a>) to rule out <a href="/wiki/Microorganisms" class="mw-redirect" title="Microorganisms">microorganisms</a> and <a href="/wiki/Fungi" class="mw-redirect" title="Fungi">fungi</a>.<sup id="cite_ref-99" class="reference"><a href="#cite_note-99"><span class="cite-bracket">[</span>99<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-100" class="reference"><a href="#cite_note-100"><span class="cite-bracket">[</span>100<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Bau2011_12-2" class="reference"><a href="#cite_note-Bau2011-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-101" class="reference"><a href="#cite_note-101"><span class="cite-bracket">[</span>101<span class="cite-bracket">]</span></a></sup> </p><p>Serum markers of sarcoidosis, include: <a href="/wiki/Serum_amyloid_A" title="Serum amyloid A">serum amyloid A</a>, soluble <a href="/wiki/Interleukin-2_receptor" class="mw-redirect" title="Interleukin-2 receptor">interleukin-2 receptor</a>, <a href="/wiki/Lysozyme" title="Lysozyme">lysozyme</a>, <a href="/wiki/Angiotensin_converting_enzyme" class="mw-redirect" title="Angiotensin converting enzyme">angiotensin converting enzyme</a>, and the glycoprotein KL-6.<sup id="cite_ref-MSRW_102-0" class="reference"><a href="#cite_note-MSRW-102"><span class="cite-bracket">[</span>102<span class="cite-bracket">]</span></a></sup> Angiotensin-converting enzyme blood levels are used in the monitoring of sarcoidosis.<sup id="cite_ref-MSRW_102-1" class="reference"><a href="#cite_note-MSRW-102"><span class="cite-bracket">[</span>102<span class="cite-bracket">]</span></a></sup> A <a href="/wiki/Bronchoalveolar_lavage" title="Bronchoalveolar lavage">bronchoalveolar lavage</a> can show an elevated (of at least 3.5) CD4/CD8 T cell ratio, which is indicative (but not proof) of pulmonary sarcoidosis.<sup id="cite_ref-MSR_26-5" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> In at least one study the induced sputum ratio of CD4/CD8 and level of TNF was correlated to those in the lavage fluid.<sup id="cite_ref-MSRW_102-2" class="reference"><a href="#cite_note-MSRW-102"><span class="cite-bracket">[</span>102<span class="cite-bracket">]</span></a></sup> A sarcoidosis-like lung disease called <a href="/wiki/Granulomatous%E2%80%93lymphocytic_interstitial_lung_disease" title="Granulomatous–lymphocytic interstitial lung disease">granulomatous–lymphocytic interstitial lung disease</a> can be seen in patients with <a href="/wiki/Common_variable_immunodeficiency" title="Common variable immunodeficiency">common variable immunodeficiency</a> (CVID) and therefore serum antibody levels should be measured to exclude CVID.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2020)">citation needed</span></a></i>]</sup> </p><p>Differential diagnosis includes metastatic disease, lymphoma, septic emboli, <a href="/wiki/Rheumatoid_nodule" title="Rheumatoid nodule">rheumatoid nodules</a>, <a href="/wiki/Granulomatosis_with_polyangiitis" title="Granulomatosis with polyangiitis">granulomatosis with polyangiitis</a>, <a href="/wiki/Varicella_zoster_virus" title="Varicella zoster virus">varicella</a> infection, <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>, and atypical infections, such as <i><a href="/wiki/Mycobacterium_avium" class="mw-redirect" title="Mycobacterium avium">Mycobacterium avium</a></i> complex, <a href="/wiki/Cytomegalovirus" title="Cytomegalovirus">cytomegalovirus</a>, and <a href="/wiki/Cryptococcus" title="Cryptococcus">cryptococcus</a>.<sup id="cite_ref-103" class="reference"><a href="#cite_note-103"><span class="cite-bracket">[</span>103<span class="cite-bracket">]</span></a></sup> Sarcoidosis is confused most commonly with neoplastic diseases, such as lymphoma, or with disorders characterized also by a mononuclear cell granulomatous inflammatory process, such as the mycobacterial and fungal disorders.<sup id="cite_ref-Harrison_28-14" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>Chest radiograph changes are divided into four stages:<sup id="cite_ref-104" class="reference"><a href="#cite_note-104"><span class="cite-bracket">[</span>104<span class="cite-bracket">]</span></a></sup> </p> <ol><li><a href="/wiki/Bihilar_lymphadenopathy" class="mw-redirect" title="Bihilar lymphadenopathy">bihilar lymphadenopathy</a></li> <li>bihilar lymphadenopathy and reticulonodular infiltrates</li> <li>bilateral pulmonary infiltrates</li> <li>fibrocystic sarcoidosis typically with upward hilar retraction, cystic and bullous changes</li></ol> <p>Although people with stage 1 radiographs tend to have the acute or subacute, reversible form of the disease, those with stages 2 and 3 often have the chronic, progressive disease; these patterns do not represent consecutive "stages" of sarcoidosis. Thus, except for epidemiologic purposes, this categorization is mostly of historic interest.<sup id="cite_ref-Harrison_28-15" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>In sarcoidosis presenting in the Caucasian population, hilar adenopathy and erythema nodosum are the most common initial symptoms. In this population, a biopsy of the gastrocnemius muscle is a useful tool in correctly diagnosing the person. The presence of a noncaseating <a href="/wiki/Epithelioid_cell" title="Epithelioid cell">epithelioid</a> granuloma in a gastrocnemius specimen is definitive evidence of sarcoidosis, as other tuberculoid and fungal diseases extremely rarely present histologically in this muscle.<sup id="cite_ref-105" class="reference"><a href="#cite_note-105"><span class="cite-bracket">[</span>105<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Cardiac_magnetic_resonance_imaging" title="Cardiac magnetic resonance imaging">Cardiac magnetic resonance imaging</a> (CMR) is one modality for diagnosing cardiac sarcoidosis. It has 78% specificity in diagnosing cardiac sarcoidosis.<sup id="cite_ref-Yatsynovich_2018_38-1" class="reference"><a href="#cite_note-Yatsynovich_2018-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Its <a href="/wiki/MRI_sequence#T1_and_T2" class="mw-redirect" title="MRI sequence">T2-weighted imaging</a> can detect acute inflammation. Meanwhile, <a href="/wiki/Cardiac_magnetic_resonance_imaging#Late_gadolinium_enhancement" title="Cardiac magnetic resonance imaging">late gadolinium contrast</a> (LGE) can detect fibrosis or scar. Lesions at the subpericardium and midwall enhancement of basal septum or inferolateral wall is strongly suggestive of sarcoidosis.<sup id="cite_ref-Yatsynovich_2018_38-2" class="reference"><a href="#cite_note-Yatsynovich_2018-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> MRI can also follow up on the treatment efficacy of corticosteroids and <a href="/wiki/Prognosis" title="Prognosis">prognosis</a> of cardiac sarcoidosis.<sup id="cite_ref-106" class="reference"><a href="#cite_note-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> </p><p>PET scan is able to quantify disease activity which cannot be performed by CMR.<sup id="cite_ref-107" class="reference"><a href="#cite_note-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup> </p> <ul class="gallery mw-gallery-packed"> <li class="gallerybox" style="width: 173.33333333333px"> <div class="thumb" style="width: 171.33333333333px;"><span typeof="mw:File"><a href="/wiki/File:HilarAdenopathy.png" class="mw-file-description" title="Hilar adenopathy especially on the person's left (AP CXR)"><img alt="Hilar adenopathy especially on the person's left (AP CXR)" src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/HilarAdenopathy.png/257px-HilarAdenopathy.png" decoding="async" width="172" height="150" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/HilarAdenopathy.png/386px-HilarAdenopathy.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b8/HilarAdenopathy.png/514px-HilarAdenopathy.png 2x" data-file-width="799" data-file-height="699" /></a></span></div> <div class="gallerytext">Hilar adenopathy especially on the person's left (AP CXR)</div> </li> <li class="gallerybox" style="width: 140px"> <div class="thumb" style="width: 138px;"><span typeof="mw:File"><a href="/wiki/File:HilarAdenopathyLt.png" class="mw-file-description" title="Hilar adenopathy especially on the person's left (lateral CXR)"><img alt="Hilar adenopathy especially on the person's left (lateral CXR)" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/de/HilarAdenopathyLt.png/207px-HilarAdenopathyLt.png" decoding="async" width="138" height="150" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/de/HilarAdenopathyLt.png/310px-HilarAdenopathyLt.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/de/HilarAdenopathyLt.png/413px-HilarAdenopathyLt.png 2x" data-file-width="909" data-file-height="990" /></a></span></div> <div class="gallerytext">Hilar adenopathy especially on the person's left (lateral CXR)</div> </li> <li class="gallerybox" style="width: 178.66666666667px"> <div class="thumb" style="width: 176.66666666667px;"><span typeof="mw:File"><a href="/wiki/File:HilarAdenopathyCCor.png" class="mw-file-description" title="Hilar adenopathy especially on the person's left (coronal CT)"><img alt="Hilar adenopathy especially on the person's left (coronal CT)" src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e2/HilarAdenopathyCCor.png/265px-HilarAdenopathyCCor.png" decoding="async" width="177" height="150" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e2/HilarAdenopathyCCor.png/397px-HilarAdenopathyCCor.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e2/HilarAdenopathyCCor.png/529px-HilarAdenopathyCCor.png 2x" data-file-width="938" data-file-height="798" /></a></span></div> <div class="gallerytext">Hilar adenopathy especially on the person's left (coronal CT)</div> </li> <li class="gallerybox" style="width: 199.33333333333px"> <div class="thumb" style="width: 197.33333333333px;"><span typeof="mw:File"><a href="/wiki/File:HilarAdenopathyCT.png" class="mw-file-description" title="Hilar adenopathy especially on the person's left (transverse CT)"><img alt="Hilar adenopathy especially on the person's left (transverse CT)" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/34/HilarAdenopathyCT.png/296px-HilarAdenopathyCT.png" decoding="async" width="198" height="150" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/34/HilarAdenopathyCT.png/445px-HilarAdenopathyCT.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/34/HilarAdenopathyCT.png/592px-HilarAdenopathyCT.png 2x" data-file-width="990" data-file-height="753" /></a></span></div> <div class="gallerytext">Hilar adenopathy especially on the person's left (transverse CT)</div> </li> </ul> <div class="mw-heading mw-heading3"><h3 id="Classification">Classification</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=18" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Sarcoidosis may be divided into the following types:<sup id="cite_ref-Andrews_36-1" class="reference"><a href="#cite_note-Andrews-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 18em;"> <ul><li><a href="/wiki/Annular_sarcoidosis" class="mw-redirect" title="Annular sarcoidosis">Annular sarcoidosis</a></li> <li><a href="/wiki/Erythrodermic_sarcoidosis" class="mw-redirect" title="Erythrodermic sarcoidosis">Erythrodermic sarcoidosis</a></li> <li><a href="/wiki/Ichthyosiform_sarcoidosis" class="mw-redirect" title="Ichthyosiform sarcoidosis">Ichthyosiform sarcoidosis</a></li> <li><a href="/wiki/Hypopigmented_sarcoidosis" class="mw-redirect" title="Hypopigmented sarcoidosis">Hypopigmented sarcoidosis</a></li> <li><a href="/wiki/L%C3%B6fgren_syndrome" title="Löfgren syndrome">Löfgren syndrome</a></li> <li><a href="/wiki/Lupus_pernio" title="Lupus pernio">Lupus pernio</a></li> <li><a href="/wiki/Morpheaform_sarcoidosis" class="mw-redirect" title="Morpheaform sarcoidosis">Morpheaform sarcoidosis</a></li> <li><a href="/wiki/Mucosal_sarcoidosis" class="mw-redirect" title="Mucosal sarcoidosis">Mucosal sarcoidosis</a></li> <li><a href="/wiki/Neurosarcoidosis" title="Neurosarcoidosis">Neurosarcoidosis</a></li> <li><a href="/wiki/Papular_sarcoid" class="mw-redirect" title="Papular sarcoid">Papular sarcoid</a></li> <li><a href="/wiki/Scar_sarcoid" class="mw-redirect" title="Scar sarcoid">Scar sarcoid</a></li> <li><a href="/wiki/Subcutaneous_sarcoidosis" class="mw-redirect" title="Subcutaneous sarcoidosis">Subcutaneous sarcoidosis</a></li> <li><a href="/wiki/Systemic_sarcoidosis" class="mw-redirect" title="Systemic sarcoidosis">Systemic sarcoidosis</a></li> <li><a href="/wiki/Ulcerative_sarcoidosis" class="mw-redirect" title="Ulcerative sarcoidosis">Ulcerative sarcoidosis</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=19" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Treatments for sarcoidosis vary greatly depending on the patient.<sup id="cite_ref-108" class="reference"><a href="#cite_note-108"><span class="cite-bracket">[</span>108<span class="cite-bracket">]</span></a></sup> At least half of patients require no systemic therapy.<sup id="cite_ref-BaughmanOct2015_109-0" class="reference"><a href="#cite_note-BaughmanOct2015-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> Most people (>75%) only require symptomatic treatment with <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drugs</a> (NSAIDs) like <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a> or <a href="/wiki/Aspirin" title="Aspirin">aspirin</a>.<sup id="cite_ref-MSRT_110-0" class="reference"><a href="#cite_note-MSRT-110"><span class="cite-bracket">[</span>110<span class="cite-bracket">]</span></a></sup> For those presenting with lung symptoms, unless the respiratory impairment is devastating, active pulmonary sarcoidosis is observed usually without therapy for two to three months; if the inflammation does not subside spontaneously, therapy is instituted.<sup id="cite_ref-Harrison_28-16" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>Major categories of drug interventions include <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a>, <a href="/wiki/Antimetabolite" title="Antimetabolite">antimetabolites</a>, biologic agents especially monoclonal anti-tumor necrosis factor antibodies.<sup id="cite_ref-BaughmanOct2015_109-1" class="reference"><a href="#cite_note-BaughmanOct2015-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> Investigational treatments include specific <a href="/wiki/Antibiotics" class="mw-redirect" title="Antibiotics">antibiotic</a> combinations and <a href="/wiki/Mesenchymal_stem_cells" class="mw-redirect" title="Mesenchymal stem cells">mesenchymal stem cells</a>.<sup id="cite_ref-BaughmanOct2015_109-2" class="reference"><a href="#cite_note-BaughmanOct2015-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> If drug intervention is indicated, a step-wise approach is often used to explore alternatives in order of increasing side effects and to monitor potentially toxic effects.<sup id="cite_ref-BaughmanOct2015_109-3" class="reference"><a href="#cite_note-BaughmanOct2015-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a>, most commonly <a href="/wiki/Prednisone" title="Prednisone">prednisone</a> or <a href="/wiki/Prednisolone" title="Prednisolone">prednisolone</a>, have been the standard treatment for many years.<sup id="cite_ref-nunes_19-9" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> In some people, this treatment can slow or reverse the course of the disease, but other people do not respond to steroid therapy. The use of corticosteroids in mild disease is controversial because in many cases the disease remits spontaneously.<sup id="cite_ref-111" class="reference"><a href="#cite_note-111"><span class="cite-bracket">[</span>111<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-112" class="reference"><a href="#cite_note-112"><span class="cite-bracket">[</span>112<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Antimetabolites">Antimetabolites</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=20" title="Edit section: Antimetabolites"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Antimetabolites, also categorized as <a href="/wiki/Steroid-sparing_agent" class="mw-redirect" title="Steroid-sparing agent">steroid-sparing agents</a>, such as <a href="/wiki/Azathioprine" title="Azathioprine">azathioprine</a>, <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, <a href="/wiki/Mycophenolic_acid" title="Mycophenolic acid">mycophenolic acid</a>, and <a href="/wiki/Leflunomide" title="Leflunomide">leflunomide</a><sup id="cite_ref-113" class="reference"><a href="#cite_note-113"><span class="cite-bracket">[</span>113<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-chest2012_114-0" class="reference"><a href="#cite_note-chest2012-114"><span class="cite-bracket">[</span>114<span class="cite-bracket">]</span></a></sup> are often used as alternatives to corticosteroids.<sup id="cite_ref-nunes_19-10" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-king_115-0" class="reference"><a href="#cite_note-king-115"><span class="cite-bracket">[</span>115<span class="cite-bracket">]</span></a></sup> Of these, methotrexate is most widely used and studied.<sup id="cite_ref-king_115-1" class="reference"><a href="#cite_note-king-115"><span class="cite-bracket">[</span>115<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-resp2013_116-0" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> Methotrexate is considered a first-line treatment in neurosarcoidosis, often in conjunction with corticosteroids.<sup id="cite_ref-neuro2012_54-7" class="reference"><a href="#cite_note-neuro2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-king_115-2" class="reference"><a href="#cite_note-king-115"><span class="cite-bracket">[</span>115<span class="cite-bracket">]</span></a></sup> Long-term treatment with methotrexate is associated with liver damage in about 10% of people and hence may be a significant concern in people with liver involvement and requires regular liver function test monitoring.<sup id="cite_ref-nunes_19-11" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Methotrexate can also lead to pulmonary toxicity (lung damage), although this is fairly uncommon and more commonly it can confound the leukopenia caused by sarcoidosis.<sup id="cite_ref-nunes_19-12" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Due to these safety concerns it is often recommended that methotrexate is combined with folic acid in order to prevent toxicity.<sup id="cite_ref-nunes_19-13" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Azathioprine treatment can also lead to liver damage.<sup id="cite_ref-resp2013_116-1" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> However, the risk of infection appears to be about 40% lower in those treated with methotrexate instead of azathioprine.<sup id="cite_ref-117" class="reference"><a href="#cite_note-117"><span class="cite-bracket">[</span>117<span class="cite-bracket">]</span></a></sup> Leflunomide is being used as a replacement for methotrexate, possibly due to its purportedly lower rate of pulmonary toxicity.<sup id="cite_ref-resp2013_116-2" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> Mycophenolic acid has been used successfully in uveal sarcoidosis,<sup id="cite_ref-118" class="reference"><a href="#cite_note-118"><span class="cite-bracket">[</span>118<span class="cite-bracket">]</span></a></sup> neurosarcoidosis (especially CNS sarcoidosis; minimally effective in sarcoidosis myopathy),<sup id="cite_ref-119" class="reference"><a href="#cite_note-119"><span class="cite-bracket">[</span>119<span class="cite-bracket">]</span></a></sup> and pulmonary sarcoidosis.<sup id="cite_ref-120" class="reference"><a href="#cite_note-120"><span class="cite-bracket">[</span>120<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-121" class="reference"><a href="#cite_note-121"><span class="cite-bracket">[</span>121<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Immunosuppressants">Immunosuppressants</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=21" title="Edit section: Immunosuppressants"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As the granulomas are caused by collections of immune system cells, particularly <a href="/wiki/T_cell" title="T cell">T cells</a>, there has been some success using immunosuppressants (like <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>, <a href="/wiki/Cladribine" title="Cladribine">cladribine</a>,<sup id="cite_ref-122" class="reference"><a href="#cite_note-122"><span class="cite-bracket">[</span>122<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Chlorambucil" title="Chlorambucil">chlorambucil</a>, and <a href="/wiki/Cyclosporine" class="mw-redirect" title="Cyclosporine">cyclosporine</a>), immunomodulatory (<a href="/wiki/Pentoxifylline" title="Pentoxifylline">pentoxifylline</a> and <a href="/wiki/Thalidomide" title="Thalidomide">thalidomide</a>), and anti-<a href="/wiki/Tumor_necrosis_factor" title="Tumor necrosis factor">tumor necrosis factor</a> treatment<sup id="cite_ref-123" class="reference"><a href="#cite_note-123"><span class="cite-bracket">[</span>123<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-124" class="reference"><a href="#cite_note-124"><span class="cite-bracket">[</span>124<span class="cite-bracket">]</span></a></sup> (such as <a href="/wiki/Infliximab" title="Infliximab">infliximab</a>, <a href="/wiki/Etanercept" title="Etanercept">etanercept</a>, <a href="/wiki/Golimumab" title="Golimumab">golimumab</a>, and <a href="/wiki/Adalimumab" title="Adalimumab">adalimumab</a>).<sup id="cite_ref-MSRP_17-1" class="reference"><a href="#cite_note-MSRP-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ther2013_125-0" class="reference"><a href="#cite_note-ther2013-125"><span class="cite-bracket">[</span>125<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-126" class="reference"><a href="#cite_note-126"><span class="cite-bracket">[</span>126<span class="cite-bracket">]</span></a></sup> </p><p>In a clinical trial cyclosporine added to prednisone treatment failed to demonstrate any significant benefit over prednisone alone in people with pulmonary sarcoidosis, although there was evidence of increased toxicity from the addition of cyclosporine to the steroid treatment including infections, malignancies (cancers), <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>, and kidney dysfunction.<sup id="cite_ref-resp2013_116-3" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> Likewise chlorambucil and cyclophosphamide are seldom used in the treatment of sarcoidosis due to their high degree of toxicity, especially their potential for causing malignancies.<sup id="cite_ref-or2013_127-0" class="reference"><a href="#cite_note-or2013-127"><span class="cite-bracket">[</span>127<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Infliximab" title="Infliximab">Infliximab</a> has been used successfully to treat pulmonary sarcoidosis in clinical trials in a number of cases.<sup id="cite_ref-resp2013_116-4" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Etanercept" title="Etanercept">Etanercept</a>, on the other hand, has failed to demonstrate any significant efficacy in people with uveal sarcoidosis in a couple of clinical trials.<sup id="cite_ref-resp2013_116-5" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> Likewise <a href="/wiki/Golimumab" title="Golimumab">golimumab</a> has failed to show any benefit in those with pulmonary sarcoidosis.<sup id="cite_ref-resp2013_116-6" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> One clinical trial of <a href="/wiki/Adalimumab" title="Adalimumab">adalimumab</a> found treatment response in about half of subjects, which is similar to that seen with infliximab, but as adalimumab has better tolerability profile it may be preferred over infliximab.<sup id="cite_ref-resp2013_116-7" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Specific_organ_treatments">Specific organ treatments</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=22" title="Edit section: Specific organ treatments"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Ursodeoxycholic_acid" title="Ursodeoxycholic acid">Ursodeoxycholic acid</a> has been used successfully as a treatment for cases with liver involvement.<sup id="cite_ref-128" class="reference"><a href="#cite_note-128"><span class="cite-bracket">[</span>128<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Thalidomide" title="Thalidomide">Thalidomide</a> has also been tried successfully as a treatment for treatment-resistant <a href="/wiki/Lupus_pernio" title="Lupus pernio">lupus pernio</a> in a clinical trial, which may stem from its anti-TNF activity, although it failed to exhibit any efficacy in a pulmonary sarcoidosis clinical trial.<sup id="cite_ref-cyt_92-2" class="reference"><a href="#cite_note-cyt-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ther2013_125-1" class="reference"><a href="#cite_note-ther2013-125"><span class="cite-bracket">[</span>125<span class="cite-bracket">]</span></a></sup> Cutaneous disease may be successfully managed with antimalarials (such as <a href="/wiki/Chloroquine" title="Chloroquine">chloroquine</a> and <a href="/wiki/Hydroxychloroquine" title="Hydroxychloroquine">hydroxychloroquine</a>) and the <a href="/wiki/Tetracycline_antibiotic" class="mw-redirect" title="Tetracycline antibiotic">tetracycline antibiotic</a>, <a href="/wiki/Minocycline" title="Minocycline">minocycline</a>.<sup id="cite_ref-Harrison_28-17" class="reference"><a href="#cite_note-Harrison-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ther2013_125-2" class="reference"><a href="#cite_note-ther2013-125"><span class="cite-bracket">[</span>125<span class="cite-bracket">]</span></a></sup> Antimalarials have also demonstrated efficacy in treating sarcoidosis-induced hypercalcemia and neurosarcoidosis.<sup id="cite_ref-nunes_19-14" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Long-term use of antimalarials is limited, however, by their potential to cause irreversible blindness and hence the need for regular ophthalmologic screening.<sup id="cite_ref-or2013_127-1" class="reference"><a href="#cite_note-or2013-127"><span class="cite-bracket">[</span>127<span class="cite-bracket">]</span></a></sup> This toxicity is usually less of a problem with <a href="/wiki/Hydroxychloroquine" title="Hydroxychloroquine">hydroxychloroquine</a> than with <a href="/wiki/Chloroquine" title="Chloroquine">chloroquine</a>, although hydroxychloroquine can disturb the glucose homeostasis.<sup id="cite_ref-or2013_127-2" class="reference"><a href="#cite_note-or2013-127"><span class="cite-bracket">[</span>127<span class="cite-bracket">]</span></a></sup> </p><p>Recently selective <a href="/wiki/Phosphodiesterase_4" title="Phosphodiesterase 4">phosphodiesterase 4</a> (PDE4) inhibitors like <a href="/wiki/Apremilast" title="Apremilast">apremilast</a> (a thalidomide derivative), <a href="/wiki/Roflumilast" title="Roflumilast">roflumilast</a>, and the less subtype-selective <a href="/wiki/PDE4_inhibitor" title="PDE4 inhibitor">PDE4 inhibitor</a>, <a href="/wiki/Pentoxifylline" title="Pentoxifylline">pentoxifylline</a>, have been tried as a treatment for sarcoidosis, with successful results being obtained with apremilast in cutaneous sarcoidosis in a small open-label study.<sup id="cite_ref-129" class="reference"><a href="#cite_note-129"><span class="cite-bracket">[</span>129<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-130" class="reference"><a href="#cite_note-130"><span class="cite-bracket">[</span>130<span class="cite-bracket">]</span></a></sup> Pentoxifylline has been used successfully to treat acute disease although its use is greatly limited by its gastrointestinal toxicity (mostly nausea, vomiting, and diarrhea).<sup id="cite_ref-chest2012_114-1" class="reference"><a href="#cite_note-chest2012-114"><span class="cite-bracket">[</span>114<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-resp2013_116-8" class="reference"><a href="#cite_note-resp2013-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-or2013_127-3" class="reference"><a href="#cite_note-or2013-127"><span class="cite-bracket">[</span>127<span class="cite-bracket">]</span></a></sup> Case reports have supported the efficacy of <a href="/wiki/Rituximab" title="Rituximab">rituximab</a>, an anti-<a href="/wiki/CD20" title="CD20">CD20</a> monoclonal antibody and a clinical trial investigating <a href="/wiki/Atorvastatin" title="Atorvastatin">atorvastatin</a> as a treatment for sarcoidosis is under-way.<sup id="cite_ref-131" class="reference"><a href="#cite_note-131"><span class="cite-bracket">[</span>131<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-132" class="reference"><a href="#cite_note-132"><span class="cite-bracket">[</span>132<span class="cite-bracket">]</span></a></sup> <a href="/wiki/ACE_inhibitors" class="mw-redirect" title="ACE inhibitors">ACE inhibitors</a> have been reported to cause remission in cutaneous sarcoidosis and improvement in pulmonary sarcoidosis, including improvement in pulmonary function, remodeling of lung parenchyma and prevention of pulmonary fibrosis in separate case series'.<sup id="cite_ref-pmid17492847_133-0" class="reference"><a href="#cite_note-pmid17492847-133"><span class="cite-bracket">[</span>133<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-134" class="reference"><a href="#cite_note-134"><span class="cite-bracket">[</span>134<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Nicotine" title="Nicotine">Nicotine</a> patches have been found to possess anti-inflammatory effects in sarcoidosis patients, although whether they had <a href="/wiki/Disease-modifying_treatment" title="Disease-modifying treatment">disease-modifying effects</a> requires further investigation.<sup id="cite_ref-135" class="reference"><a href="#cite_note-135"><span class="cite-bracket">[</span>135<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Antimycobacterial" title="Antimycobacterial">Antimycobacterial</a> treatment (drugs that kill off mycobacteria, the causative agents behind <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a> and <a href="/wiki/Leprosy" title="Leprosy">leprosy</a>) has also proven itself effective in treating chronic cutaneous (that is, it affects the skin) sarcoidosis in one clinical trial.<sup id="cite_ref-136" class="reference"><a href="#cite_note-136"><span class="cite-bracket">[</span>136<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Quercetin" title="Quercetin">Quercetin</a> has also been tried as a treatment for pulmonary sarcoidosis with some early success in one small trial.<sup id="cite_ref-137" class="reference"><a href="#cite_note-137"><span class="cite-bracket">[</span>137<span class="cite-bracket">]</span></a></sup> </p><p>Because of its uncommon nature, the treatment of male reproductive tract sarcoidosis is controversial. Since the differential diagnosis includes <a href="/wiki/Testicular_cancer" title="Testicular cancer">testicular cancer</a>, some recommend <a href="/wiki/Orchiectomy" title="Orchiectomy">orchiectomy</a>, even if evidence of sarcoidosis in other organs is present. In the newer approach, testicular, epididymal biopsy and resection of the largest lesion has been proposed.<sup id="cite_ref-Paknejad_269–27_67-3" class="reference"><a href="#cite_note-Paknejad_269–27-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Symptoms">Symptoms</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=23" title="Edit section: Symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with sarcoidosis may have a range of symptoms that do not correspond with objective physical evidence of disease but that still decrease <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a>.<sup id="cite_ref-Drent2015_138-0" class="reference"><a href="#cite_note-Drent2015-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup> </p><p>Physical therapy, rehabilitation, and counseling can help avoid deconditioning,<sup id="cite_ref-Drent2015_138-1" class="reference"><a href="#cite_note-Drent2015-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 733">: 733 </span></sup> and improve social participation, psychological well-being, and activity levels. Key aspects are avoiding exercise intolerance and muscle weakness.<sup id="cite_ref-Drent2015_138-2" class="reference"><a href="#cite_note-Drent2015-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 734">: 734 </span></sup> </p><p>Low or moderate-intensity physical training has been shown to improve fatigue, psychological health, and physical functioning in people sarcoidosis without adverse effects.<sup id="cite_ref-Marcellis_2015_139-0" class="reference"><a href="#cite_note-Marcellis_2015-139"><span class="cite-bracket">[</span>139<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Strookappe2015_140-0" class="reference"><a href="#cite_note-Strookappe2015-140"><span class="cite-bracket">[</span>140<span class="cite-bracket">]</span></a></sup> Inspiratory muscle training has also decreased severe fatigue perception in subjects with early stages of sarcoidosis, as well as improving functional and maximal exercise capacity and respiratory muscle strength.<sup id="cite_ref-141" class="reference"><a href="#cite_note-141"><span class="cite-bracket">[</span>141<span class="cite-bracket">]</span></a></sup> The duration, frequency, and physical intensity of exercise needs to accommodate impairments such as joint pain, muscle pain, and fatigue.<sup id="cite_ref-Drent2015_138-3" class="reference"><a href="#cite_note-Drent2015-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 734">: 734 </span></sup><sup id="cite_ref-Strookappe2015_140-1" class="reference"><a href="#cite_note-Strookappe2015-140"><span class="cite-bracket">[</span>140<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-142" class="reference"><a href="#cite_note-142"><span class="cite-bracket">[</span>142<span class="cite-bracket">]</span></a></sup> </p><p>Neurostimulants such as <a href="/wiki/Methylphenidate" title="Methylphenidate">methylphenidate</a> and <a href="/wiki/Modafinil" title="Modafinil">modafinil</a> have shown some effectiveness as an adjunct for treatment of sarcoidosis fatigue.<sup id="cite_ref-Drent2015_138-4" class="reference"><a href="#cite_note-Drent2015-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 733">: 733 </span></sup><sup id="cite_ref-143" class="reference"><a href="#cite_note-143"><span class="cite-bracket">[</span>143<span class="cite-bracket">]</span></a></sup> </p><p>Treatments for symptomatic neuropathic pain in sarcoidosis patients is similar to that for other causes, and include <a href="/wiki/Antidepressant" title="Antidepressant">antidepressants</a>, <a href="/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsants</a> and prolonged-release <a href="/wiki/Opioid" title="Opioid">opioids</a>, however, only 30 to 60% of patients experience limited pain relief.<sup id="cite_ref-Drent2015_138-5" class="reference"><a href="#cite_note-Drent2015-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 733">: 733 </span></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=24" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Sarcoidosis_-_Honeycombing.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9f/Sarcoidosis_-_Honeycombing.jpg/220px-Sarcoidosis_-_Honeycombing.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9f/Sarcoidosis_-_Honeycombing.jpg/330px-Sarcoidosis_-_Honeycombing.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9f/Sarcoidosis_-_Honeycombing.jpg/440px-Sarcoidosis_-_Honeycombing.jpg 2x" data-file-width="3072" data-file-height="2048" /></a><figcaption>Gross pathology image showing sarcoidosis with honeycombing: Prominent honeycombing is present in the lower lobes accompanied by fibrosis and some honeycombing in the upper lungs. Honeycombing consists of cystically dilated airways separated by scar tissue resembling the honeycomb of bees. It is a nonspecific end stage of many types of interstitial lung disease.</figcaption></figure> <p>The disease can remit spontaneously or become chronic, with exacerbations and remissions. In some cases, it can progress to <a href="/wiki/Pulmonary_fibrosis" title="Pulmonary fibrosis">pulmonary fibrosis</a> and death. In benign cases, remission can occur in 24 to 36 months without treatment but regular follow ups are required. Some cases, however, may persist several decades.<sup id="cite_ref-nunes_19-15" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Two-thirds of people with the condition achieve a remission within 10 years of the diagnosis.<sup id="cite_ref-144" class="reference"><a href="#cite_note-144"><span class="cite-bracket">[</span>144<span class="cite-bracket">]</span></a></sup> When the heart is involved, the prognosis is generally less favourable, though corticosteroids appear effective in improving AV conduction.<sup id="cite_ref-Syed04_145-0" class="reference"><a href="#cite_note-Syed04-145"><span class="cite-bracket">[</span>145<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-146" class="reference"><a href="#cite_note-146"><span class="cite-bracket">[</span>146<span class="cite-bracket">]</span></a></sup> The prognosis tends to be less favourable in African Americans than in white Americans.<sup id="cite_ref-MSR_26-6" class="reference"><a href="#cite_note-MSR-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> In a Swedish population-based analysis, the majority of cases who did not have severe disease at diagnosis had comparable mortality to the general population.<sup id="cite_ref-:0_147-0" class="reference"><a href="#cite_note-:0-147"><span class="cite-bracket">[</span>147<span class="cite-bracket">]</span></a></sup> The risk for premature death was markedly (2.3-fold) increased compared to the general population for a smaller group of cases with severe disease at diagnosis.<sup id="cite_ref-:0_147-1" class="reference"><a href="#cite_note-:0-147"><span class="cite-bracket">[</span>147<span class="cite-bracket">]</span></a></sup> Serious infections, sometimes multiple during the course of disease, and heart failure might contribute to the higher risk of early death in some patients with sarcoidosis.<sup id="cite_ref-:3_148-0" class="reference"><a href="#cite_note-:3-148"><span class="cite-bracket">[</span>148<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-149" class="reference"><a href="#cite_note-149"><span class="cite-bracket">[</span>149<span class="cite-bracket">]</span></a></sup> </p><p>Some 1990s studies indicated that people with sarcoidosis appear to be at significantly increased risk for cancer, in particular <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a>, <a href="/wiki/Lymphoma" title="Lymphoma">lymphomas</a>,<sup id="cite_ref-Karakantza-1996_150-0" class="reference"><a href="#cite_note-Karakantza-1996-150"><span class="cite-bracket">[</span>150<span class="cite-bracket">]</span></a></sup> and cancer in other organs known to be affected in sarcoidosis.<sup id="cite_ref-151" class="reference"><a href="#cite_note-151"><span class="cite-bracket">[</span>151<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-152" class="reference"><a href="#cite_note-152"><span class="cite-bracket">[</span>152<span class="cite-bracket">]</span></a></sup> In sarcoidosis-lymphoma syndrome, sarcoidosis is followed by the development of a <a href="/wiki/Lymphoproliferative_disorder" class="mw-redirect" title="Lymphoproliferative disorder">lymphoproliferative disorder</a> such as <a href="/wiki/Non-Hodgkin_lymphoma" title="Non-Hodgkin lymphoma">non-Hodgkin lymphoma</a>.<sup id="cite_ref-pmid11907791_153-0" class="reference"><a href="#cite_note-pmid11907791-153"><span class="cite-bracket">[</span>153<span class="cite-bracket">]</span></a></sup> This may be attributed to the underlying immunological abnormalities that occur during the sarcoidosis disease process.<sup id="cite_ref-pmid17917102_154-0" class="reference"><a href="#cite_note-pmid17917102-154"><span class="cite-bracket">[</span>154<span class="cite-bracket">]</span></a></sup> Sarcoidosis can also follow cancer<sup id="cite_ref-Sarcoidosis_Occurring_After_Lymphoma_155-0" class="reference"><a href="#cite_note-Sarcoidosis_Occurring_After_Lymphoma-155"><span class="cite-bracket">[</span>155<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid15659510_156-0" class="reference"><a href="#cite_note-pmid15659510-156"><span class="cite-bracket">[</span>156<span class="cite-bracket">]</span></a></sup> or occur concurrently with cancer.<sup id="cite_ref-pmid10705270_157-0" class="reference"><a href="#cite_note-pmid10705270-157"><span class="cite-bracket">[</span>157<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid19531456_158-0" class="reference"><a href="#cite_note-pmid19531456-158"><span class="cite-bracket">[</span>158<span class="cite-bracket">]</span></a></sup> There have been reports of <a href="/wiki/Hairy_cell_leukemia" title="Hairy cell leukemia">hairy cell leukemia</a>,<sup id="cite_ref-pmid14513061_159-0" class="reference"><a href="#cite_note-pmid14513061-159"><span class="cite-bracket">[</span>159<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Acute_myeloid_leukemia" title="Acute myeloid leukemia">acute myeloid leukemia</a>,<sup id="cite_ref-pmid1548666_160-0" class="reference"><a href="#cite_note-pmid1548666-160"><span class="cite-bracket">[</span>160<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Acute_myeloblastic_leukemia" class="mw-redirect" title="Acute myeloblastic leukemia">acute myeloblastic leukemia</a><sup id="cite_ref-pmid3855267_161-0" class="reference"><a href="#cite_note-pmid3855267-161"><span class="cite-bracket">[</span>161<span class="cite-bracket">]</span></a></sup> associated with sarcoidosis. Sometimes, sarcoidosis, even untreated, can be complicated by opportunistic infections although these are rare.<sup id="cite_ref-162" class="reference"><a href="#cite_note-162"><span class="cite-bracket">[</span>162<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-163" class="reference"><a href="#cite_note-163"><span class="cite-bracket">[</span>163<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:3_148-1" class="reference"><a href="#cite_note-:3-148"><span class="cite-bracket">[</span>148<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=25" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Sarcoidosis most commonly affects young adults of both sexes, although studies have reported more cases in females. Incidence is highest for individuals younger than 40 and peaks in the age-group from 20 to 29 years; a second peak is observed for women over 50.<sup id="cite_ref-nunes_19-16" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Syed04_145-1" class="reference"><a href="#cite_note-Syed04-145"><span class="cite-bracket">[</span>145<span class="cite-bracket">]</span></a></sup> </p><p>Sarcoidosis occurs throughout the world in all races with an average incidence of 16.5 per 100,000 in men and 19 per 100,000 in women. The disease is most common in Northern European countries and the highest annual incidence of 60 per 100,000 is found in Sweden and Iceland. In the United Kingdom the prevalence is 16 in 100,000.<sup id="cite_ref-164" class="reference"><a href="#cite_note-164"><span class="cite-bracket">[</span>164<span class="cite-bracket">]</span></a></sup> In the United States, sarcoidosis is more common in people of <a href="/wiki/African_descent" class="mw-redirect" title="African descent">African descent</a> than <a href="/wiki/Caucasian_race" title="Caucasian race">Caucasians</a>, with annual incidence reported as 35.5 and 10.9 per 100,000, respectively.<sup id="cite_ref-Henke_165-0" class="reference"><a href="#cite_note-Henke-165"><span class="cite-bracket">[</span>165<span class="cite-bracket">]</span></a></sup> Sarcoidosis is less commonly reported in South America, Spain, India, Canada, and the Philippines. There may be a higher susceptibility to sarcoidosis in those with <a href="/wiki/Celiac_disease" class="mw-redirect" title="Celiac disease">celiac disease</a>. An association between the two disorders has been suggested.<sup id="cite_ref-166" class="reference"><a href="#cite_note-166"><span class="cite-bracket">[</span>166<span class="cite-bracket">]</span></a></sup> </p><p>There also has been a seasonal clustering observed in sarcoidosis-affected individuals.<sup id="cite_ref-lancet_167-0" class="reference"><a href="#cite_note-lancet-167"><span class="cite-bracket">[</span>167<span class="cite-bracket">]</span></a></sup> In Greece about 70% of diagnoses occur between March and May every year, in Spain about 50% of diagnoses occur between April and June, and in Japan it is mostly diagnosed during June and July.<sup id="cite_ref-lancet_167-1" class="reference"><a href="#cite_note-lancet-167"><span class="cite-bracket">[</span>167<span class="cite-bracket">]</span></a></sup> </p><p>The differing incidence across the world may be at least partially attributable to the lack of screening programs in certain regions of the world, and the overshadowing presence of other granulomatous diseases, such as <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>, that may interfere with the diagnosis of sarcoidosis where they are prevalent.<sup id="cite_ref-Syed04_145-2" class="reference"><a href="#cite_note-Syed04-145"><span class="cite-bracket">[</span>145<span class="cite-bracket">]</span></a></sup> There may also be differences in the severity of the disease between people of different ethnicities. Several studies suggest the presentation in people of African origin may be more severe and disseminated than for Caucasians, who are more likely to have asymptomatic disease.<sup id="cite_ref-AJR1999_69-1" class="reference"><a href="#cite_note-AJR1999-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> Manifestation appears to be slightly different according to race and sex. <a href="/wiki/Erythema_nodosum" title="Erythema nodosum">Erythema nodosum</a> is far more common in men than in women and in Caucasians than in other races. In Japanese people, ophthalmologic and cardiac involvement are more common than in other races.<sup id="cite_ref-nunes_19-17" class="reference"><a href="#cite_note-nunes-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>It is more common in certain occupations, namely <a href="/wiki/Firefighters" class="mw-redirect" title="Firefighters">firefighters</a>, educators, military personnel, those who work in industries where pesticides are used, law enforcement, and healthcare personnel.<sup id="cite_ref-env2009_168-0" class="reference"><a href="#cite_note-env2009-168"><span class="cite-bracket">[</span>168<span class="cite-bracket">]</span></a></sup> In the year after the <a href="/wiki/September_11_attacks" title="September 11 attacks">September 11 attacks</a>, the rate of sarcoidosis incidence went up four-fold (to 86 cases per 100,000).<sup id="cite_ref-nat2011_31-4" class="reference"><a href="#cite_note-nat2011-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-env2009_168-1" class="reference"><a href="#cite_note-env2009-168"><span class="cite-bracket">[</span>168<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=26" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>It was first described in 1877 by Dr. <a href="/wiki/Jonathan_Hutchinson" title="Jonathan Hutchinson">Jonathan Hutchinson</a>, a <a href="/wiki/Dermatologist" class="mw-redirect" title="Dermatologist">dermatologist</a> as a condition causing red, raised rashes on the face, arms, and hands.<sup id="cite_ref-hutch_15-1" class="reference"><a href="#cite_note-hutch-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> In 1889 the term <a href="/wiki/Lupus_pernio" title="Lupus pernio">lupus pernio</a> was coined by Dr. <a href="/wiki/Ernest_Besnier" title="Ernest Besnier">Ernest Besnier</a>, another dermatologist.<sup id="cite_ref-histb_169-0" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> Later in 1892 lupus pernio's <a href="/wiki/Histology" title="Histology">histology</a> was defined.<sup id="cite_ref-histb_169-1" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> In 1902 bone involvement was first described by a group of three doctors.<sup id="cite_ref-histb_169-2" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> Between 1909 and 1910 uveitis in sarcoidosis was first described, and later in 1915 it was emphasised, by Dr. <a href="/wiki/J%C3%B6rgen_Nielsen_Schaumann" title="Jörgen Nielsen Schaumann">Jörgen Nielsen Schaumann</a>, that it was a systemic condition.<sup id="cite_ref-histb_169-3" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> This same year lung involvement was also described.<sup id="cite_ref-histb_169-4" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> In 1937 <a href="/wiki/Heerfordt_syndrome" title="Heerfordt syndrome">uveoparotid fever</a> was first described and likewise in 1941 <a href="/wiki/L%C3%B6fgren_syndrome" title="Löfgren syndrome">Löfgren syndrome</a> was first described.<sup id="cite_ref-histb_169-5" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> In 1958 the first international conference on sarcoidosis was called in London, likewise the first USA sarcoidosis conference occurred in Washington, D.C., in the year 1961.<sup id="cite_ref-histb_169-6" class="reference"><a href="#cite_note-histb-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> It has also been called <a href="/wiki/Ernest_Besnier" title="Ernest Besnier">Besnier</a>–<a href="/wiki/C%C3%A6sar_Peter_M%C3%B8ller_Boeck" title="Cæsar Peter Møller Boeck">Boeck</a> disease or <a href="/wiki/Ernest_Besnier" title="Ernest Besnier">Besnier</a>–<a href="/wiki/C%C3%A6sar_Peter_M%C3%B8ller_Boeck" title="Cæsar Peter Møller Boeck">Boeck</a>–<a href="/wiki/J%C3%B6rgen_Nielsen_Schaumann" title="Jörgen Nielsen Schaumann">Schaumann</a> disease.<sup id="cite_ref-170" class="reference"><a href="#cite_note-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Etymology">Etymology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=27" title="Edit section: Etymology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The word "sarcoidosis" comes from Greek [σάρκο-] <i>sarco-</i> meaning "flesh", the suffix <i>-(e)ido</i> (from the Greek εἶδος -eidos [usually omitting the initial e in English as the diphthong epsilon-iota in Classic Greek stands for a long "i" = English ee]) meaning "type", " resembles" or "like", and <i>-sis</i>, a common suffix in Greek meaning "condition". Thus the whole word means "a condition that resembles crude flesh". The first cases of sarcoïdosis, which were recognised as a new pathological entity, in Scandinavia, at the end of the 19th century exhibited skin nodules resembling cutaneous sarcomas, hence the name initially given.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2020)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=28" title="Edit section: Society and culture"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) is an organisation of physicians involved in the diagnosis and treatment of sarcoidosis and related conditions.<sup id="cite_ref-171" class="reference"><a href="#cite_note-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup> WASOG publishes the journal <i>Sarcoidosis, Vasculitis and Diffuse Lung Diseases</i>.<sup id="cite_ref-172" class="reference"><a href="#cite_note-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup> Additionally, the Foundation for Sarcoidosis Research (FSR) is devoted to supporting research into sarcoidosis and its possible treatments.<sup id="cite_ref-173" class="reference"><a href="#cite_note-173"><span class="cite-bracket">[</span>173<span class="cite-bracket">]</span></a></sup> </p><p>There have been concerns that <a href="/wiki/World_Trade_Center_(1973%E2%80%932001)" title="World Trade Center (1973–2001)">World Trade Center</a> rescue workers are at a heightened risk for sarcoidosis.<sup id="cite_ref-174" class="reference"><a href="#cite_note-174"><span class="cite-bracket">[</span>174<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-175" class="reference"><a href="#cite_note-175"><span class="cite-bracket">[</span>175<span class="cite-bracket">]</span></a></sup> </p><p>Comedian and actor <a href="/wiki/Bernie_Mac" title="Bernie Mac">Bernie Mac</a> had sarcoidosis. In 2005, he mentioned that the disease was in remission.<sup id="cite_ref-Grimes_176-0" class="reference"><a href="#cite_note-Grimes-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup> His death on August 9, 2008, was caused by complications from <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a>, though Mac's agent states the sarcoidosis was not related to his fatal pneumonia.<sup id="cite_ref-Death_177-0" class="reference"><a href="#cite_note-Death-177"><span class="cite-bracket">[</span>177<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Karen_Duffy" title="Karen Duffy">Karen "Duff" Duffy</a>, <a href="/wiki/MTV" title="MTV">MTV</a> personality and actress, was diagnosed with neurosarcoidosis in 1995.<sup id="cite_ref-178" class="reference"><a href="#cite_note-178"><span class="cite-bracket">[</span>178<span class="cite-bracket">]</span></a></sup> </p><p>American football player <a href="/wiki/Reggie_White" title="Reggie White">Reggie White</a> died in 2004, with pulmonary and cardiac sarcoidosis being contributing factors to his fatal heart arrhythmia.<sup id="cite_ref-179" class="reference"><a href="#cite_note-179"><span class="cite-bracket">[</span>179<span class="cite-bracket">]</span></a></sup> </p><p>Singer <a href="/wiki/Sean_Levert" title="Sean Levert">Sean Levert</a> died in 2008 of sarcoidosis complications.<sup id="cite_ref-180" class="reference"><a href="#cite_note-180"><span class="cite-bracket">[</span>180<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Manning_Marable" title="Manning Marable">Manning Marable</a>, a professor of public policy at Columbia University, died of pneumonia in 2011, less than a year after undergoing a double lung transplant following a diagnosis of sarcoidosis. In 2012, he was posthumously awarded a Pulitzer Prize in history for his biography "<a href="/wiki/Malcolm_X:_A_Life_of_Reinvention" title="Malcolm X: A Life of Reinvention">Malcolm X: A Life of Reinvention</a>." </p><p><a href="/wiki/Joseph_Rago" title="Joseph Rago">Joseph Rago</a>, Pulitzer Prize-winning writer known for his work at <i>The Wall Street Journal</i>, died of sarcoidosis complications in 2017.<sup id="cite_ref-181" class="reference"><a href="#cite_note-181"><span class="cite-bracket">[</span>181<span class="cite-bracket">]</span></a></sup> </p><p>Several historical figures are suspected of having sarcoidosis. In a 2014 letter to the British medical journal <i><a href="/wiki/The_Lancet" title="The Lancet">The Lancet</a></i>, it was suggested that the <a href="/wiki/French_Revolution" title="French Revolution">French Revolution</a> leader <a href="/wiki/Maximilien_Robespierre" title="Maximilien Robespierre">Maximilien Robespierre</a> may have had sarcoidosis, causing him impairment during his time as head of the <a href="/wiki/Reign_of_Terror" title="Reign of Terror">Reign of Terror</a>.<sup id="cite_ref-pmid24360387_182-0" class="reference"><a href="#cite_note-pmid24360387-182"><span class="cite-bracket">[</span>182<span class="cite-bracket">]</span></a></sup> The symptoms associated with <a href="/wiki/Ludwig_van_Beethoven" title="Ludwig van Beethoven">Ludwig van Beethoven</a>'s 1827 death have been described as possibly consistent with sarcoidosis.<sup id="cite_ref-183" class="reference"><a href="#cite_note-183"><span class="cite-bracket">[</span>183<span class="cite-bracket">]</span></a></sup> Author <a href="/wiki/Robert_Louis_Stevenson" title="Robert Louis Stevenson">Robert Louis Stevenson</a> (1850–1894) had a history of chronic coughs and chest complaints, and sarcoidosis has been suggested as a diagnosis.<sup id="cite_ref-184" class="reference"><a href="#cite_note-184"><span class="cite-bracket">[</span>184<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pregnancy">Pregnancy</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=29" title="Edit section: Pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Sarcoidosis generally does not prevent successful pregnancy and delivery; the increase in estrogen levels during pregnancy may even have a slightly beneficial immunomodulatory effect. In most cases, the course of the disease is unaffected by pregnancy, with improvement in a few cases and worsening of symptoms in very few cases, although a number of the immunosuppressants (such as <a href="/wiki/Methotrexate" title="Methotrexate">methotrexate</a>, <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a>) used in corticosteroid-refractory sarcoidosis are known <a href="/wiki/Teratogens" class="mw-redirect" title="Teratogens">teratogens</a>.<sup id="cite_ref-pregnancy_185-0" class="reference"><a href="#cite_note-pregnancy-185"><span class="cite-bracket">[</span>185<span class="cite-bracket">]</span></a></sup> Increased risks associated with sarcoidosis ranging from 30 to 70% have been reported for preeclampsia/eclampsia, cesarian or preterm delivery as well as (non-cardiac) birth defects in first singleton pregnancies.<sup id="cite_ref-:2_186-0" class="reference"><a href="#cite_note-:2-186"><span class="cite-bracket">[</span>186<span class="cite-bracket">]</span></a></sup> In absolute numbers, birth defects and other complications such as maternal death, cardiac arrest, placental abruption or venous thromboembolism are extremely rare in sarcoidosis pregnancies.<sup id="cite_ref-:2_186-1" class="reference"><a href="#cite_note-:2-186"><span class="cite-bracket">[</span>186<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Sarcoidosis&action=edit&section=30" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFKonstantinidis2005" class="citation book cs1">Konstantinidis G (2005). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=lCKRIT-7X6UC&pg=PA1454"><i>Elsevier's Dictionary of Medicine and Biology: in English, Greek, German, Italian and Latin</i></a>. Elsevier. p. 1454. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-08-046012-3" title="Special:BookSources/978-0-08-046012-3"><bdi>978-0-08-046012-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Elsevier%27s+Dictionary+of+Medicine+and+Biology%3A+in+English%2C+Greek%2C+German%2C+Italian+and+Latin&rft.pages=1454&rft.pub=Elsevier&rft.date=2005&rft.isbn=978-0-08-046012-3&rft.aulast=Konstantinidis&rft.aufirst=G&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DlCKRIT-7X6UC%26pg%3DPA1454&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASarcoidosis" class="Z3988"></span></span> </li> <li id="cite_note-NIH2013What-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-NIH2013What_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-NIH2013What_2-12"><sup><i><b>m</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.nhlbi.nih.gov/health/health-topics/topics/sarc">"What Is Sarcoidosis?"</a>. <i>NHLBI</i>. June 14, 2013. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20160406004249/http://www.nhlbi.nih.gov/health/health-topics/topics/sarc">Archived</a> from the original on 6 April 2016<span class="reference-accessdate">. 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title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Respiratory+Research&rft.atitle=Maternal+and+infant+outcomes+in+sarcoidosis+pregnancy%3A+a+Swedish+population-based+cohort+study+of+first+births&rft.volume=21&rft.issue=1&rft.pages=225&rft.date=2020-08&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC7457286%23id-name%3DPMC&rft_id=info%3Apmid%2F32854707&rft_id=info%3Adoi%2F10.1186%2Fs12931-020-01493-y&rft.aulast=K%C3%B6cher&rft.aufirst=L&rft.au=Rossides%2C+M&rft.au=Remaeus%2C+K&rft.au=Grunewald%2C+J&rft.au=Eklund%2C+A&rft.au=Kullberg%2C+S&rft.au=Arkema%2C+EV&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC7457286&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASarcoidosis" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a 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class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q193894" class="extiw" title="d:Q193894">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/D86">D86</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=135">135</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/181000">181000</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D012507">D012507</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb11797.htm">11797</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000076.htm">000076</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/2063-overview">med/2063</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/sarcoidosis-pro">Sarcoidosis</a></li><li><b><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a></b>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=797">797</a></li></ul></div></div></td></tr></tbody></table></div> <ul><li><a rel="nofollow" class="external text" href="https://www.sarcoidosisuk.org/information-hub/">Sarcoidosis UK Information Hub</a></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFIannuzzi,_M._C.Sah,_B._P.2008" class="citation book cs1">Iannuzzi, M. C.; Sah, B. P. (March 2008). <a rel="nofollow" class="external text" href="http://www.merckmanuals.com/home/lung_and_airway_disorders/interstitial_lung_diseases/sarcoidosis.html"><i>Sarcoidosis: Interstitial Lung Diseases</i></a>. Merck Sharp & Dohme Corp<span class="reference-accessdate">. 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