Sarcoidosis
Sarcoidosis is a relatively uncommon disease which in India,
has been more commonly diagnosed in the last few years. Unlike diseases such as asthma, tuberculosis,
pneumonias and lung cancer, sarcoidosis is rather an unfamiliar term amongst
patients. It is somewhat difficult to
understand and appreciate the nuances of sarcoidosis.
A patient with sarcoidosis may present with varied
manifestations. Commonly, there are
symptoms of low grade fever, weakness, malaise, joint pains, dry cough and/or
breathlessness. Sometimes, the patient
is entirely asymptomatic and the diagnosis is made incidentally on chest x-ray
examination. While lungs are the most frequently
involved organs, skin, eyes, liver, spleen and nervous system are the other
common sites of disease. Almost any part
of the body can be involved in sarcoidosis.
The exact cause of sarcoidosis is not known. This is quite enigmatic for both the patient
and the doctor to accept a relatively indefinable disease. It is an immunological disorder but the exact
aberrations are not known. There are a
number of clinical, radiological and histopathological similarities with
tuberculosis. But tuberculosis and
sarcoidosis are two distinct diseases with entirely different treatments.
Sarcoidosis is generally suspected on clinical and
radiological criteria. The diagnosis is
confirmed on histopathological findings of biopsies from the involved organs,
for example the lungs, lymph nodes or liver (etc.). Bronchoscopy, and often endo-bronchial
ultrasound (EBUS) guided fine needle aspirations are required to obtain biopsy
material from the lungs and the lymph nodes.
It is important to confirm the diagnosis in view of the treatment issues
involving the use of corticosteroids, generally for prolonged periods. It is also important to exclude other
diseases such as tuberculosis and lymphomas.
Sarcoidosis is a treatable disease, but recurrences may
occur. Strict monitoring is required for
side-effects of drugs such as the corticosteroids, during the treatment. The response to the treatment is fairly
good. Recurrence of disease requires
treatment with alternate drugs which may not be as effective as the corticosteroids.
Sarcoidosis involving the heart and the nervous system is
considered as more serious. In chronic
cases, sarcoidosis may result in diffuse lung fibrosis and respiratory
disability. These cases respond poorly
to standard modes of therapy. Overall
prognosis of sarcoidosis is generally good provided the disease is diagnosed
before any permanent damage has occurred.
A considered decision is always important before the
treatment is instituted. These cases are diagnosed with the help of biopsies
from the involved organ/s. Most often, they need fiberoptic bronchoscopy to
obtain transbronchial and endo-bronchial lung biopsy. This is particularly so because the
sarcoidosis treatment requires corticosteroid administration, which are avoided
in case there is the possibility of an alternate diagnosis, such as tuberculosis
(or lymphomas).EBUS guided fine needle aspiration biopsy adds to the accuracy
of obtaining tissues especially in case only the thoracic lymph nodes are
involved.
We at our centre, see around 1-2 new cases of sarcoidosis
every week, the diagnostic success with bronchoscopic procedures is almost 100
percent. This further emphasizes the frequency of its occurrence and the need
for proper diagnosis.
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