Sarcoidosis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate sarcoidosis:

Acute sarcoidosis

Leading symptoms

• Arthritis (inflammation of the joint) – typically affecting the ankle joint
• Erythema nodosum* (synonyms: nodular erythema, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa) (25% of cases) – granulomatous inflammation of the subcutis (subcutaneous fat tissue), also known as panniculitis, and a pressure-dolent (painful) nodule (red to blue-red color; later brownish). The overlying skin is reddened (= erythematous). Localization: both lower leg extensor sides, on the knee and ankle joints; less frequently on the arms or buttocksNote: areal, erythematous, pressure-dolent nodules → X-ray of the thorax in two projections required to exclude sarcoidosis.
• Biilar adenopathy (hilar lymphadenopathy) – lymph node changes affecting both lungs (90% of cases of sarcoidosis have pulmonary changes).

* Note: Any patient who presents with areal, erythematous (“associated with redness of the skin“), pressure-suppressed nodules is suspicious for sarcoidosis. In such cases, a chest (thoracic) x-ray in two planes is required for further diagnosis. Other symptoms

• Fever
• Cough

Note: An acute form of sarcoidosis is Löfgren’s syndrome (synonym: bilateral hilar lymphoma syndrome): combination symptomatology consisting of:

• Bihilary lymphadenopathy (bihilary adenopathy; see above).
• Ankle arthritis (inflammatory joint disease).
• Erythema nodosum (see above).
• Fever

Löfgren’s syndrome is particularly common in women of Scandinavian, African or Puerto Rican origin.

Chronic sarcoidosis

• Fatigue – however, chronic sarcoidosis is often asymptomatic (without symptoms) in the beginning

Later symptoms (indicative of progressive pulmonary fibrosis):

• Irritative cough
• Exertional dyspnea – shortness of breath on exertion.

Usually sufferers feel relatively well, but the findings on chest X-ray are pronounced.

Early Onset Sarcoidosis (EOS)

Leading symptoms

• Arthritis (inflammation of the joints)
• Uveitis – inflammation of the middle skin of the eye (uvea), which consists of the choroid, the corpus ciliare, and the iris
• Exanthem (rash)

Other symptoms

• Anorexia (loss of appetite)
• Fever
• Hepatosplenomegaly – enlargement of the liver and spleen.
• Fatigue

Extrapulmonary (occurring outside the lungs) symptomatology

• Skin lesions (30% of cases) such as:
  • Erythema nodosum (see above).
  • Reddish-brown papules (from Latin papula “vesicle” or nodule).
  • Lupus pernio (large nodular form of sarcoidosis; extensive, livid infiltration of nose, cheeks, earlobes).
  • Cicatricial sarcoidosis (yellow-brownish changes on scars).
• Eye involvement (25-50%) such as:
  • Ligamentous keratopathy (disease of the cornea of the eye), fittings in the Arlt triangle, interstitial keratitis – as corneal manifestation.
  • Iridocyclitis – inflammation of the iris and ciliary body.
  • Calcification
  • Lacrimal gland infestation
  • Uveitis – inflammation of the middle eye skin (see above).
• Cardiac involvement such as:
  • Cardiac arrhythmias, especially AV block.
  • Heart failure (cardiac insufficiency)
  • Pericardial effusion – accumulation of fluid in the pericardium.
• Bone involvement such as:
  • Ostitis multiplex cystoides – cystic transformation of the fingers.
• Liver and spleen (25-70%; see “Other symptoms” above).
• Involvement of the nervous system (neurosarcoidosis; in about 10% of all sarcoidosis cases, the peripheral or central nervous system or musculature are also affected) such as:
  • Diabetes insipidus – disease associated with increased urine output (polyuria) and an increased sense of thirst with polydipsia (increased drinking)
  • Cranial nerve deficits (50-70% of all cases of neurosarcoidosis): facial nerve palsy (paralysis of the facial nerve; most common); furthermore, optic nerve, glossopharyngeal nerve and vagus nerve.
  • Aseptic meningitis/granulomatous meningitis (meningitis).
  • Granulomas in the parenchyma of the CNS (20-50% of all cases of neurosarcoidosis).
  • Anterior pituitary insufficiency (HVL insufficiency) – inability of the pituitary gland (pituitary gland) to produce sufficient hormones.
  • Spinal manifestations
  • Peripheral nervous system: granulomas that may involve both epi- and perineurium; acute and chronic demyelinating polyneuropathies.
  • Muscle involvement (2-5% of all neurosarcoidosis cases).
  • If applicable, psychiatric symptoms, unspecified (20% of all cases of neurosarcoidosis).
• Parotitis (parotid gland inflammation).

Basically, all organ systems can be affected.

Heerfordt syndrome (febris uveoparotidea)

Combination symptomatology consisting of:

• Fever
• Facial paresis (see above).
• Parotitis (parotid gland inflammation).
• Uveitis (see above)