A complete discussion of the clinical features of sarcoidosis is beyond the scope of this chapter. Briefly, sarcoidosis most commonly affects the lungs, where it may be asymptomatic or cause symptoms of dyspnea, dry cough, wheezing, and chest pain. Lung rales are heard in less than 20% of patients. The diagnosis may be aided by chest radiograph and highresolution chest CT scan showing bilateral, symmetrical lymphadenopathy with or without pulmonary interstitial opacities. Sarcoidosis may also affect other organs (Table 4). Laboratory findings include anemia, leucopenia, thrombocytopenia, hypercalcemia, elevated erythrocyte sedimentation rate, hypergammaglobulinemia, and a positive test for rheumatoid factor (due to chronic immune stimulation). The serum levels of ACE are elevated in 75% of untreated patients with sarcoidosis, but a positive test is not diagnostically specific, and its value in monitoring disease activity is controversial (30,33).
TABLE 4 Other Organ Systems in Sarcoidosis
>25% Abnormal liver blood tests, hepatomegaly, rare portal hypertension or hepatic failure 25% Splenomegaly and less frequent pressure symptoms, anemia, leukopenia, thrombocytopenia 5% Benign arrhythmias, palpitations, high-degree heart block, syncope, sudden death <1% Mimic tumor, infection, or inflammatory bowel disease in the stomach, esophagus, appendix, rectum, and pancreas <1% Interstitial nephritis, membranous nephropathy, crescentic glomerulonephritis, tumor-like masses <1% Asymptomatic mass of uterus or testicle, epididymitis <1% Diffuse goiter, nodules, hypothyroidism, hyperthyroidism
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