Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Also known as Boeck sarcoid, benign lymphogranulomatosis• Noncaseating granulomatous disease involving lungs, liver, spleen, lymph, skin, and bones• Cause is unknown• 20% have myocardial involvement• 30% have cutaneous involvement• 70% have hepatic and splenic involvement• Mediastinal and scalene lymph nodes microscopically involved in 90% and 80%, respectively +++ Epidemiology + • Highest incidence: Scandinavia, England, United States• Incidence in blacks 15 fold that of whites• 50% between ages 20 and 40 years• Women affected more often than men +++ Symptoms and Signs + • May present with nonspecific pulmonary symptoms (20-30%), including fever (15%) and cough• Erythema nodosum may herald onset• Weight loss, fatigue, weakness, malaise, enlarged lymph nodes (75%)• Migratory or persistent polyarthritis• CNS symptoms (rarely) +++ Laboratory Findings + • Elevated serum and bronchoalveolar ACE levels• Elevated lysozyme levels +++ Imaging Findings + • Chest film: 5 stages-Stage 0: No abnormality-Stage 1: Hilar/mediastinal adenopathy alone-Stage 2: Hilar adenopathy with pulmonary abnormalities-Stage 3: Diffuse pulmonary disease without adenopathy-Stage 4: Pulmonary fibrosis• Mediastinal lymph node involvement characteristically bilateral and symmetric• Asymmetric hilar adenopathy: Consider lymphoma or other disease• Pleural effusions/cavitation rare: Consider TB, pneumonia + • Diagnosis of exclusion• Suggested by chest film, gallium 67 scanning, elevated serum and bronchoalveolar ACE and lysozyme levels• Pathologic documentation of noncaseating granulomas via transbronchial or mediastinoscopy +++ Rule Out + • Hodgkin disease• Non-Hodgkin lymphoma + • Chest x-ray• Chest CT scan• Bronchoscopy and biopsy if pulmonary compromise + • No therapy needed for asymptomatic patients• Corticosteroids for patients with pulmonary impairment or are symptomatic +++ Complications + • Corticosteroid side effects +++ Prognosis + • Long-term mortality as high as 10% +++ References ++Paramothayan S et al. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis. Cochrane Database Syst Rev. 2003;(3):CD003536. Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.