Rare Diseases Types What Is Sarcoidosis? By Mary Kugler, RN Mary Kugler, RN, is a pediatric nurse whose specialty is caring for children with long-term or severe medical problems. Learn about our editorial process Mary Kugler, RN Medically reviewed by Medically reviewed by Caitilin Kelly, MD on January 17, 2020 Caitilin Kelly, MD, is board-certified in internal medicine. She is clinical physician practicing at Indiana University Health Bloomington Hospital and the chair of the American College of Physicians' Hospital Ethics committee. She is a delegate for the Indiana State Medical Association House of Delegates. Learn about our Medical Review Board Caitilin Kelly, MD Updated on October 25, 2020 Print Table of Contents View All Symptoms Causes Diagnosis Treatment Sarcoidosis is an inflammatory disease that produces lumps of cells (granulomas) within various organs and tissues throughout the body—most commonly the lungs. While the precise cause is unknown, researchers suspect that sarcoidosis develops when the immune system of a genetically susceptible person responds to something in the environment. Many people with sarcoidosis have no symptoms, so the disease may be discovered during a medical evaluation of another concern. Verywell / Gary Ferster Sarcoidosis Symptoms The fact that not everyone with sarcoidosis experiences symptoms makes it a rather unique disease. If symptoms are present, they are usually constitutional or related to the lung. Constitutional symptoms of sarcoidosis can include: FeverFatigueWeight lossMalaise Lung-related symptoms of sarcoidosis can include: Shortness of breathDry coughWheezingChest discomfort Sarcoidosis may affect various other organs and tissues, including the muscles, joints, eyes, skin, nerves, lymph nodes, liver, and spleen. Some potential symptoms/signs include: Muscle and joint: Muscle weakness/aches and joint pain/swellingEye: Dry, itchy, and/or burning eyes, blurred vision, or sensitivity to lightSkin: New rashes, like erythema nodosum (red, tender nodules on the shin) or lupus pernio (skin sores on or inside the nose, on the cheeks, ears, eyelids or fingers)Nerves: Facial weakness or paralysis, as well as numbness and tinglingLymph nodes: Enlarged lymph nodes, especially in the neck (cervical) and above the collarbone (supraclavicular)Liver: Right-sided abdominal discomfort and mild elevation in liver enzymesSpleen: Left-sided abdominal discomfort and anemia or other blood abnormalitiesCentral nervous system: Encephalopathy; granulomas; meningitis Sarcoidosis may also affect the heart and cause heart failure, abnormal heart rhythms, and even sudden death. The Dangers of Cardiac Sarcoidosis Kidney problems may also occur with sarcoidosis and lead to problems with calcium regulation. High calcium levels in the blood (called hypercalcemia) and urine (called hypercalciuria) can then cause kidney stones and eventually, kidney failure. There are multiple other kidney diseases seen with increased frequency with sarcoidosis, including different kinds of nephritis. Twenty-five percent of people with sarcoidosis get some kind of eye involvement, including uveitis. Lastly, various glands in the body may be affected by sarcoidosis, such as the pituitary gland, thyroid, and parotid gland. Causes The cause of sarcoidosis remains unknown, although experts suspect that both genetics and some sort of environmental exposure are likely involved. Some environmental sources that have been evaluated as potential triggers of the development of sarcoidosis in a genetically vulnerable person are various viruses, like the herpes virus, as well as various bacteria, such as Mycobacterium (the bacterium that causes tuberculosis) and Propionibacterium acnes (a bacterium found on the skin). Non-infectious exposures have also been examined, including organic dust, solvents, molds/mildew, pesticides, beryllium, aluminum, zirconium, and wood stoves. None of these exposures have been definitively linked and more studies are needed. Diagnosis Diagnosing sarcoidosis is often challenging because there is no single blood or imaging test that can clinch the diagnosis. Instead, the diagnosis of sarcoidosis is based on four main factors: A detailed medical history and complete physical examImaging and other diagnostic testsA sample (biopsy) of affected tissueDiagnostic studies that rule out potential diseases that mimic sarcoidosis Given that sarcoidosis may not present with symptoms, the disease is sometimes discovered incidentally when a person has a physical exam or a chest X-ray for some other reason. Medical History and Physical Exam During the medical history, a doctor may become suspicious for sarcoidosis if a patient's main symptoms are lung-related and accompanied by constitutional symptoms, like fever. In addition, a patient's age and race can provide a clue to the potential diagnosis. More than 80% of sarcoidosis cases occur in adults between the ages of 20 and 50. Moreover, African-Americans are approximately three to four times more likely to develop sarcoidosis than whites. When it comes to the physical exam, signs of sarcoidosis are often subtle or nonspecific, such as wheezing heard in the lungs. That said, in some cases, the physical exam findings are more obvious, and if they are found in combination (for example, the eruption of an erythema nodosum rash, along with a fever and multiple joint pains), the diagnosis of sarcoidosis becomes more evident. Imaging and Other Diagnostic Tests A variety of imaging and other tests are usually performed to help make the diagnosis of sarcoidosis. These tests often include the following: Chest X-ray: The two classic findings seen on a chest X-ray of a patient with sarcoidosis are enlargement of the lymph nodes on both sides of the chest (bilateral hilar lymphadenopathy) and pulmonary (lung) infiltratesHigh resolution computed tomography (HRCT) scan of the chestPulmonary function tests (PFTs)Electrocardiogram (ECG)Various blood tests: Angiotensin-converting enzyme (ACE) level, complete blood count (CBC), and comprehensive metabolic panel (CMP), to name a fewUrinalysis and urine calcium levelEye exam Biopsy During a biopsy, a small sample of tissue is removed from an organ that is affected by sarcoidosis. A biopsy may be performed on the lung or other affected organ or tissue, like a lymph node, area of skin, or enlarged parotid gland. Sometimes, two different organs are biopsied to help make the diagnosis of sarcoidosis. Once the tissue sample is removed, it is examined under a microscope for the characteristic finding of sarcoidosis—a granuloma. A Guide to Understanding Your Lung Biopsy Differential Diagnoses Several other diseases can mimic the symptoms and signs of sarcoidosis, which is why your doctor will evaluate these alternative diagnoses: Infections, like tuberculosis, histoplasmosis, or human immunodeficiency virusCancer, like lymphomaDrug-induced hypersensitivityForeign body granulomatosisHypersensitivity pneumonitisPneumoconiosis (e.g., aluminum or beryllium)Vasculitis, like Churg-Strauss syndrome or granulomatosis with polyangiitis (formally called Wegener granulomatosis) Treatment Treatment of sarcoidosis is generally only needed if symptoms are bothersome, or if the disease is progressing or affecting certain organs. For many with sarcoidosis, the granulomas resolve over time on their own or the disease does not worsen. For others, though, treatment is warranted because symptoms impair daily functioning, their disease continues to worsen over time, and/or certain organs are affected (e.g., eyes, heart, or kidney). Corticosteroids A corticosteroid—most commonly prednisone—is the mainstay of treatment for sarcoidosis. While an effective anti-inflammatory drug, the downside of prednisone therapy is its potential side effects, including weight gain, osteoporosis, diabetes mellitus, high blood pressure, gastritis, myopathy, and infection. Other Medications If a person cannot take a corticosteroid and/or their symptoms do not improve enough with a corticosteroid alone, other medications—such as one of the drugs below—may be recommended: Rheumatrex (methotrexate)Imuran (azathioprine)Arava (leflunomide)Plaquenil (hydroxychloroquine)Remicade (infliximab)Humira (adalimumab) A Word From Verywell Sarcoidosis affects people uniquely, which in turn affects a person's individual treatment plan and prognosis. If you or a loved one has sarcoidosis, be sure to see specialists (e.g., a rheumatologist, a pulmonologist) who have experience working with patients with this inflammatory condition. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Newman KL, Newman LS. Occupational causes of sarcoidosis. Curr Opin Allergy Clin Immunol. 2012;12(2):145-50. doi:10.1097/ACI.0b013e3283515173 Soto-Gomez N, Peters JI, Nambiar AM. Diagnosis and Management of Sarcoidosis. Am Fam Physician. 2016;93(10):840-850. Mehta D, Mori N, Goldbarg SH, Lubitz S, Wisnivesky JP, Teirstein A. Primary prevention of sudden cardiac death in silent cardiac sarcoidosis: role of programmed ventricular stimulation. Circ Arrhythm Electrophysiol. 2011;4(1):43-8. doi:10.1161/CIRCEP.110.958322 Saidha S, Sotirchos ES, Eckstein C. Etiology of sarcoidosis: does infection play a role? Yale J Biol Med. 2012;85(1):133-41. Wessendorf TE, Bonella F, Costabel U. Diagnosis of Sarcoidosis. Clin Rev Allergy Immunol. 2015;49(1):54-62. doi:10.1007/s12016-015-8475-x Mirsaeidi M, Machado RF, Schraufnagel D, Sweiss NJ, Baughman RP. Racial Difference in Sarcoidosis Mortality in the United States. Chest. 2015 Feb;147(2):438-49. doi: 10.1378/chest.14-1120 Beegle SH, Barba K, Gobunsuy R, Judson MA. Current and emerging pharmacological treatments for sarcoidosis: a review. Drug Des Devel Ther. 2013;7:325-38. doi:10.2147/DDDT.S31064 Broos CE, Van Nimwegen M, Hoogsteden HC, Hendriks RW, Kool M, Van den Blink B. Granuloma formation in pulmonary sarcoidosis. Front Immunol. 2013;4:437. doi:10.3389/fimmu.2013.00437 Baughman RP, Lower EE. Steroids for sarcoidosis: How much and for how long? Respir Med. 2018;138S:S5-S6. doi:10.1016/j.rmed.2017.12.009 Additional Reading King TE. (2017). Clinical manifestations and diagnosis of pulmonary sarcoidosis. Flaherty KR, ed. UpToDate. Waltham, MA: UpToDate. National Heart, Lung, and Blood Institute. (2015). Sarcoidosis.