Sarcoidosis: Complications

The following are the most important diseases or complications that may be contributed to by sarcoidosis:

Respiratory system (J00-J99)

  • Bronchiectasis (synonym: bronchiectasis)-permanent irreversible saccular or cylindrical dilatation of the bronchi (medium-sized airways) that may be congenital or acquired; symptoms: chronic cough with “mouthful expectoration” (large-volume triple-layered sputum: foam, mucus, and pus), fatigue, weight loss, and decreased exercise capacity
  • Cor pulmonale – dilatation (widening) and/or hypertrophy (enlargement) of the right ventricle (main chamber) of the heart due to pulmonary hypertension (increase in pressure in the pulmonary circulation), which may be caused by various diseases of the lungs
  • Pulmonary fibrosis – group of chronic diseases associated with remodeling of the lung skeleton (interstitial lung diseases).
  • Pulomonal hypertension – increase in pressure in the pulmonary arterial system.
  • Respiratory insufficiency – disturbance of external (mechanical) breathing; this results in inadequate ventilation of the alveoli.

Eyes and ocular appendages (H00-H59) [eye involvement: approximately 25-50% of cases; not uncommon initial manifestation]

  • Anterior uveitis – inflammation in the anterior segment of the eye (-75% of cases).
  • Iridocyclitis – inflammation of the iris (iris) and ciliary body (section of the middle eye skin; this serves the suspension of the lens and its accommodation/adjustment of the refractive power) of the eye.
  • Keratoconjunctivitis sicca (dry eye syndrome).

Blood, blood-forming organs – immune system (D50-D90).

  • Chronic sarcoidosis

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Anterior pituitary insufficiency (HVL insufficiency; hypofunction of the pituitary gland).
  • Addison’s disease – primary adrenocortical insufficiency (NNR insufficiency; adrenocortical insufficiency).

Cardiovascular system (I00-I99).

  • Heart failure (myocardial insufficiency)
  • Cardiac arrhythmias, especially AV block.
  • Myocarditis (inflammation of the heart muscle)
  • Pericarditis (inflammation of the pericardium)

Skin and subcutaneous (L00-L99)

  • Alopecia cicatrica (scarring hair loss).
  • Erythema nodosum (synonyms: nodular erysipelas, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa) – granulomatous inflammation of the subcutis (subcutaneous fat tissue), also called panniculitis, and a painful nodule (red to blue-red color; later brownish). The overlying skin is reddened. Localization: both lower leg extensor sides, on the knee and ankle joints; less frequently on the arms or buttocks.

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

  • Liver cirrhosis – irreversible (non-reversible) damage to the liver and marked remodeling of liver tissue.

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

Musculoskeletal system and connective tissue (M00-M99)

  • Osteoporosis (bone loss); probably primarily due to glucocorticoid therapy for sarcoidosis.
  • Synovitis (synovial inflammation).
  • Polyarthritides (inflammation of five or more joints).
  • Tenosynovitides (inflammation of the tendon sheath)
  • Enthesitides (inflammation in the area of tendon attachments).

Neoplasms – tumor diseases (C00-D48)

  • Tumors of the skin, hematologic system, upper digestive tract, kidney, liver, and colorectal carcinomas – a meta-analysis demonstrated a significant mean association between sarcoidosis and increased incidence of malignancy

Psyche – Nervous System (F00-F99; G00-G99).

  • Dementia
  • Granulomatous meningitis (meningitis).
  • Peripheral facial paresis – paresis (paralysis) of muscles innervated by the facial nerve, consequently part of the facial musculature is paralyzed

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Hepatosplenomegaly (enlargement of the liver and spleen.
  • Xerostomia (dry mouth)

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Focal segmental sclerosing glomerulonephritis (FSGS) – Sclerosis (hardening) and deposits in the area of the glomeruli (renal filterlets).
  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (increased excretion of protein in the urine) with a protein loss of more than 1g/m²/body surface per day; Hypoproteinemia, peripheral edema (water retention) due to hypalbuminemia of < 2.5 g/dl in serum, hyperlipoproteinemia (lipid metabolism disorder) with LDL elevation.

The risk for chronic progression depends on the following factors:

  • Age > 40 years
  • Chronic uveitis – inflammation of the middle skin of the eye (uvea), which consists of the choroid (choroid), ray body (corpus ciliare), and iris.
  • Heart involvement
  • Hypercalcemia – too high blood calcium level.
  • Lupus pernio (synonym: Lupus pernio Besnier) – large nodular form of sarcoidosis.
  • Neurosarcoidosis – sarcoidosis affecting the central nervous system.
  • Pulmonary sarcoidosis type III (see classification below).
  • Symptom duration > 6 months