Sarcoidosis

What is sarcoidosis?

Sarcoidosis is an inflammatory disease in which granulomas, or clumps of inflammatory cells, form in various organs. This causes organ inflammation. Sarcoidosis may be triggered by your body’s immune system responding to foreign substances, such as viruses, bacteria, or chemicals.

The areas of the body commonly affected by sarcoidosis include:

  • lymph nodes
  • lungs
  • eyes
  • skin
  • liver
  • heart
  • spleen
  • brain

What causes sarcoidosis?

The exact cause of sarcoidosis is unknown. However, gender, race, and genetics can increase the risk of developing the condition:

  • Sarcoidosis is more common in women than in men.
  • People of African-American descent are more likely to develop the condition.
  • People with a family history of sarcoidosis have a significantly higher risk of getting the disease.

Sarcoidosis rarely occurs in children. Symptoms usually appear in people between the ages of 20 and 40.

What are the symptoms of sarcoidosis?

Some people with sarcoidosis don’t have any symptoms. However, general symptoms may include:

Symptoms vary depending on the part of your body that’s affected by the disease. Sarcoidosis can occur in any organ, but it most commonly affects the lungs. Lung symptoms can include:

Skin symptoms can include:

Nervous system symptoms can include:

Eye symptoms can include:

  • dry eyes
  • itchy eyes
  • eye pain
  • vision loss
  • a burning sensation in your eyes
  • a discharge from your eyes

How is sarcoidosis diagnosed?

It can be difficult to diagnose sarcoidosis. Symptoms can be similar to those of other diseases, such as arthritis or cancer. Your doctor will run a variety of tests to make a diagnosis.

Your doctor will first perform a physical examination to:

  • check for skin bumps or a rash
  • look for swollen lymph nodes
  • listen to your heart and lungs
  • check for an enlarged liver or spleen

Based on the findings, your doctor may order additional diagnostic tests:

  • chest X-ray can be used to check for granulomas and swollen lymph nodes.
  • A chest CT scan is an imaging test that takes cross-sectional pictures of your chest.
  • lung function test can help determine whether your lung capacity has become affected.
  • biopsy involves taking a sample of tissue that can be checked for granulomas.

Your doctor may also order blood tests to check your kidney and liver function.

How is sarcoidosis treated?

There’s no cure for sarcoidosis. However, symptoms often improve without treatment. Your doctor may prescribe medications if your inflammation is severe. These can include corticosteroids or immunosuppressive medications (medications that suppress your immune system), which can both help reduce inflammation.

Treatment is also more likely if the disease affects your:

  • eyes
  • lungs
  • heart
  • nervous system

The length of any treatment will vary. Some people take medication for one to two years. Other people may need to be on medication for much longer.

What are the potential complications of sarcoidosis?

Most people who are diagnosed with sarcoidosis don’t experience complications. However, sarcoidosis can become a chronic, or long-term, condition. Other potential complications may include:

In rare cases, sarcoidosis causes severe heart and lung damage. If this occurs, you may need immunosuppressive medications.

It’s important to contact your doctor if you have:

  • breathing difficulties
  • heart palpitations, which occur when your heart is beating too fast or too slow
  • changes in your vision or loss of vision
  • eye pain
  • sensitivity to light
  • facial numbness

These can be signs of dangerous complications.

Your doctor may recommend that you see an optometrist or ophthalmologist because this disease can affect your eyes without causing immediate symptoms.

What is the outlook for someone with sarcoidosis?

The outlook is generally good for people with sarcoidosis. Many people live relatively healthy, active lives. Symptoms often improve with or without treatment in about two years.

In some cases, however, sarcoidosis can become a long-term condition. If you have trouble coping, you can talk to a psychotherapist or join a sarcoidosis support group.

Neurosarcoidosis

Overview

Sarcoidosis is a chronic inflammatory disease that affects various parts of your body or internal organs. It’s most commonly seen in the lungs or lymph nodes, but it can affect several different organs in the body.

Neurosarcoidosis is when this inflammatory disease affects your nervous system, such as your brain or spinal cord. It may also be called neurologic sarcoidosis. Less than 15 percent of people with sarcoidosis will develop neurosarcoidosis.

The symptoms of neurosarcoidosis tend to be similar to the symptoms of multiple sclerosis (MS) or transverse myelitis. This is because neurosarcoidosis also damages the myelin coating around the nerve fibers.

To tell the difference and to diagnose neurosarcoidosis, doctors perform one or more of the following tests:

  • chest X-ray, specifically of the lungs
  • CT scan
  • blood tests
  • biopsy

These tests or scans are the main ways for doctors to determine if your symptoms are from MS or neurosarcoidosis. Your doctor needs a correct diagnosis to decide the best treatment for you.

Symptoms

The symptoms vary for neurosarcoidosis based on what areas of the body are affected by the inflammation in the brain. Some symptoms will look similar to multiple sclerosis, depending on the affected areas.

If it affects the brain or cranial nerves, you may have:

  • headaches
  • inability or change in your ability to smell or taste
  • loss of hearing
  • confusion
  • dementia
  • seizures
  • speech difficulties
  • psychiatric issues
  • hallucinations
  • irritability
  • palsy in the facial muscles
  • double vision or other vision issues

If it affects the peripheral nerves, you may have:

  • tingling and numbness
  • weak muscles
  • inability to move some parts of the body

If the neurosarcoidosis affects the pituitary gland, you may have:

  • extreme thirst
  • the need to urinate frequently
  • severe tiredness
  • menstrual cycle changes (in women)

These symptoms can occur abruptly or appear slowly over time. Symptoms usually start when a person is between the ages of 20 and 40 years. It also seems to occur more often in people of African-American or Swedish decent.

It can be challenging to diagnose neurosarcoidosis because different areas can be affected and different symptoms occur with each area. Your doctor will usually rule out other possible reasons for your symptoms before coming to a diagnosis of neurosarcoidosis.

Causes

The specific cause of neurosarcoidosis is not known. However, researchers and medical professionals believe it may be caused by a combination of risk factors. Those factors may include:

  • genetics
  • environmental factors
  • certain infections
  • disorders of the immune system
Treatment

There is currently no cure for neurosarcoidosis, and treatments vary based on symptoms and severity.

Your doctor may prescribe corticosteroids. These help reduce the inflammation, which may help reduce your symptoms severity.

Other treatments may include:

  • immunomodulatory medications
  • immunosuppressive medications
  • occupational therapy
  • physical therapy
  • pain management medications or therapy

The medications used for treatment can have severe negative side effects that you should discuss with your doctor before you take them. The doctor will help you determine if the risk of side effects is worth the possible benefits of taking the medication.

Life expectancy and prognosis

There isn’t a standard prognosis for neurosarcoidosis because the condition differs from person to person. Some people have symptoms that may get progressively worse throughout their lifetime. However, about two-thirds of people with this condition experience remission.

Remission means that the symptoms go away. The majority of people who go into remission go on to live normal lives. Those who do not experience remission will need to manage their symptoms and continue treatments throughout their lives.

Some of the medications that can be used for treatment have serious side effects. In a small percentage of people, these side effects may include death. You should discuss all medications and their side effects with your doctor before taking them.

Outlook

Because the symptoms of neurosarcoidosis mimic other conditions, it’s important to do any diagnostic tests your doctor requests to get a correct diagnosis. Many of these tests or scans involve radiology. Be sure to discuss any concerns you may have about the tests with your doctor.

After diagnosis with neurosarcoidosis, you should regularly see a neurologist who is experienced in treating this condition. They can help you determine the best treatment for you. They will also coordinate with other doctors and therapists involved in your care. This will ensure the best outcome for you.

What You Need to Know About Lung Granulomas

Overview

Sometimes when tissue in an organ becomes inflamed — often in response to an infection — groups of cells called histiocytes cluster to form little nodules. These little bean-shaped clusters are called granulomas.

Granulomas can form anywhere in your body but most commonly develop in your:

  • skin
  • lymph nodes
  • lungs

When granulomas first form, they’re soft. Over time, they can harden and become calcified. This means calcium is forming deposits in the granulomas. The calcium deposits make these kinds of lung granulomas more easily seen on imaging tests, such as chest X-rays or CT scans.

On a chest X-ray, some lung granulomas can look like potentially cancerous growths. However, granulomas are noncancerous and often cause no symptoms nor require any treatment.

What are the symptoms?

There are seldom symptoms associated with lung granulomas themselves. However, granulomas form in response to respiratory conditions, such as sarcoidosis or histoplasmosis, so the underlying cause tends to present symptoms. These may include:

  • coughs that don’t go away
  • shortness of breath
  • chest pain
  • fever or chills
What are the causes?

The conditions most commonly associated with lung granulomas can be divided into two categories: infections and inflammatory diseases.

Among the infections are:

Histoplasmosis

One of the most common causes of lung granulomas is a type of fungal infection known as histoplasmosis. You can develop histoplasmosis by breathing in airborne spores of a fungus normally found in bird and bat droppings.

Nontuberculous mycobacteria (NTM)

NTM, which are found naturally in water and soil, are among the more common sources of bacterial infections that lead to lung granulomas.

Some noninfectious, inflammatory conditions include:

Granulomatosis with polyangiitis (GPA)

GPA is a rare but serious inflammation of the blood vessels in your nose, throat, lungs, and kidneys. It’s unclear why this condition develops, though it appears to be an abnormal immune system reaction to an infection.

Rheumatoid arthritis (RA)

RA is another abnormal response of the immune system that leads to inflammation. RA primarily affects your joints but it can cause lung granulomas, also referred to as rheumatoid nodules or lung nodules. These granulomas are usually harmless, but there’s a small risk that a rheumatoid nodule can burst and harm your lung.

Sarcoidosis

Sarcoidosis is an inflammatory condition that most often affects your lungs and lymph nodes. It appears to be caused by an abnormal immune system response, though researchers have yet to pinpoint what triggers this response. It may be related to a bacterial or viral infection, but there’s no clear evidence yet to back up that theory.

Lung granulomas related to sarcoidosis may be harmless, but some may affect your lung function.

How is it diagnosed?

Because they’re small and usually cause no symptoms, granulomas are often discovered accidentally. For example, if you’re having a routine chest X-ray or CT scan because of a respiratory problem, your doctor may discover small spots on your lungs that turn out to be granulomas. If they’re calcified, they’re especially easy to see on an X-ray.

At first look, granulomas resemble possibly cancerous tumors. A CT scan can detect smaller nodules and provide a more detailed view.

Cancerous lung nodules tend to be more irregularly shaped and larger than benign granulomas, which average 8 to 10 millimeters in diameter. Nodules higher up in your lungs are also more likely to be cancerous tumors.

If your doctor sees what appears to be a small and harmless granuloma on an X-ray or CT scan, they may monitor it for a while, taking additional images over a period of years to see if it grows.

A larger granuloma may be evaluated over time using positron emission tomography (PET) scans. This type of imaging uses the injection of a radioactive substance to identify areas of inflammation or malignancy.

Your doctor may also take a biopsy of a lung granuloma to determine if it’s cancerous. A biopsy involves removing a small piece of suspicious tissue with a thin needle or a bronchoscope, a thin tube threaded down your throat and into your lungs. The tissue sample is then examined under a microscope.

How is it treated?

Lung granulomas typically don’t require treatment, especially if you have no symptoms.

Because granulomas are usually the result of a diagnosable condition, treatment of the underlying condition is important. For example, a bacterial infection in your lungs that triggers granuloma growth should be treated with antibiotics. An inflammatory condition, such as sarcoidosis, may be treated with corticosteroids or other anti-inflammatory medications.

What’s the outlook?

Once you have the underlying cause of lung granulomas under control, you may not have additional nodules form in your lungs. Some conditions, such as sarcoidosis, have no cure, but can be fairly well managed. While you may keep inflammation levels down, it’s possible more granulomas may form.

Lung granulomas and other growths in your lungs are usually identified when your doctor is looking for other respiratory problems. That means it’s important to report symptoms such as coughing, shortness of breath, and chest pain promptly to your doctor. The sooner you have symptoms evaluated and diagnosed, the sooner you can get helpful treatment.

References:
Culver DA. (2010). Sarcoidosis.
clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/sarcoidosis/
https://www.healthline.com/reviewers/nancy-carteron-md-facr
https://www.healthline.com/authors/valencia-higuera
https://www.healthline.com/health/sarcoidosis
Learn about sarcoidosis. (n.d.).
lung.org/lung-disease/sarcoidosis/understanding-sarcoidosis.html
Mayo Clinic Staff. (2017). Sarcoidosis: Overview.
mayoclinic.org/diseases-conditions/sarcoidosis/basics/definition/con-20022569
Sarcoidosis. (n.d.).
ncbi.nlm.nih.gov/pubmedhealth/PMH0001140
Sarcoidosis. (2015).
my.clevelandclinic.org/health/diseases_conditions/hic_Overview_of_Sarcoidosis
https://www.healthline.com/reviewers/seunggu-han-md
https://www.healthline.com/authors/diana-wells
https://www.healthline.com/health/neurosarcoidosis
Gözübatik-Çelik G, et al. (2015). Diagnosis and treatment in neurosarcoidosis.
ncbi.nlm.nih.gov/pmc/articles/PMC5352991/
Iannuzzi Mc, et al. (2014). Sarcoidosis.
merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis
Mayo Clinic Staff. (2017). Sarcoidosis: Overview.
mayoclinic.org/diseases-conditions/sarcoidosis/home/ovc-20177969
Neurosarcoidosis. (n.d.).
cedars-sinai.edu/Patients/Health-Conditions/Neurosarcoidosis.aspx
Neurosarcoidosis information page. (n.d.).
ninds.nih.gov/Disorders/All-Disorders/Neurosarcoidosis-Information-Page
Pardo C. (2011). Neurosarcoidosis: Clinical, pathological and therapeutic issues.
archive.myelitis.org/newsletters/j5/journal-5-06.htm#.WUKKDWjyuwU
Stern BJ. (2015). Neurologic sarcoidosis. [Abstract].
uptodate.com/contents/neurologic-sarcoidosis
Written by James Roland — Updated on May 14, 2018
https://www.healthline.com/about/medical-team
https://www.healthline.com/about/medical-team

Indsend en kommentar