Signs and Symptoms of Sarcoidosis
Sarcoidosis is usually asymptomatic, which means there are no outward signs that the person has the disease. This is why so many cases of sarcoidosis are discovered by chance during a routine x-ray. When symptoms appear, the most common are:
- respiratory (complications with breathing)
- ophthalmological (pertaining to the eyes)
- dermatological (pertaining to the skin).
A person may experience shortness of breath (dyspnea), a dry cough that persists, skin rashes (either erythema nodosum or other types of rashes) or inflammation in the eye. Sometimes, a person with sarcoidosis complains of "feeling sick" and may experience fever or weight loss. Sarcoidosis can affect nearly any organ, with the possible exception of the adrenal gland.
Respiratory Symptoms of Sarcoidosis
In over 90 percent of patients with sarcoidosis, whether or not they show outward signs of the disease, abnormalities almost always show up on a chest x-ray. These include swelling and inflammation of the lymph nodes (lymphadenopathy) in the chest and, less commonly, a mottled (having colored spots and blotches) appearance to the lungs.
Swollen Lymph Nodes (Adenopathy) & Sarcoidosis
There are two sets of thoracic lymph nodes that are commonly affected: the hilar (where the bronchial tubes enter the lungs) and mediastinal (the region in the center of the chest just outside of the lungs).
Swollen hilar and mediastinal lymph nodes are not exclusive to sarcoidosis. There are several other underlying problems that can lead to lymphadenopathy (e.g., tuberculosis, cancer). There are differences in the type of inflammation that help differentiate the diagnoses of these disorders.
Sometimes CT scan provides a more detailed picture that can help eliminate other possibilities. In most cases, if the lymphadenopathy is bilateral (occuring on both sides of the body) and especially if it is accompanied by characteristic skin or eye lesions, it is fairly certain that the patient has sarcoidosis.
Pulmonary Infiltration and Fibrosis & Sarcoidosis
The mottled appearance of the lungs that shows up in a chest x-ray is due to what is known as "pulmonary infiltration." Infiltration refers to the abnormal presence of granulomas in the lung tissue. Depending on how severe and extensive the pulmonary infiltration is, it can cause various respiratory symptoms. The two most common are shortness of breath (dyspnea) and a persistent, dry cough. About 25 percent of sarcoidosis patients experience dyspnea and/or a persistent cough.
Pulmonary infiltration can lead to lung fibrosis (i.e., the hardening and thickening of tissue) that can cause permanent scarring. Fibrosis tends to develop in areas where the infiltration lasts a long time or where it is especially dense. Fibrosis causes the lungs to stiffen, making it difficult to breathe. Unfortunately, fibrosis is irreversible. If extensive, it can cause severe dysfunction and, at its worse, can lead to heart failure.
Although often asymptomatic, granulomas in the lung can cause assorted respiratory problems, including:
- A persistent, dry cough
- Chest pain
- Hemoptysis (spitting up of blood from the lungs)
- Nasal congestion
- Pneumothorax (air in the chest outside the lungs, which can lead to a collapsed lung)
- Shortness of breath, or difficult breathing (dyspnea), a normal result of exercise but in sarcoidosis patients can occur without exercise
- Wheezing (noisy, difficult breathing)
In the majority of patients, the inflammation and infiltration in the lungs eventually clears up. There is considerable difference among racial groups in the likelihood of the sarcoidosis clearing up without causing any permanent damage. In the United States, nearly 80 percent of stage 1 cases in Caucasians resolve spontaneously, without intervention, compared to about 33 percent of stage 1 cases in African Americans. The percentage of cases that resolve decreases as the stage increases. Generally, the older the patient is, the more likely the sarcoidosis will become chronic and lead to fibrosis.
Upper Airway Involvement & Sarcoidosis
The upper airways, including the sinuses and the larynx, can be affected with sarcoidosis. Sinus involvement can lead to recurrent sinusitis or, rarely, perforation of the nasal septum. Laryngeal involvement can lead to hoarseness and upper airway obstruction.
Endobronchial Involvement & Sarcoidosis
Granulomas can occur in the trachea or the bronchial tubes leading to airway obstruction that can cause difficulty breathing and obstructive pneumonia.
Extrathoracic Lymph Nodes & Sarcoidosis
In addition to the hilar and mediastinal lymph nodes in the chest, sarcoidosis can affect lymph nodes in other parts of the body. Affected glands are typically painless and often not palpable (cannot be felt). Lymph node involvement outside of the thoracic region is more common among African Americans than Caucasians.
Ophthalmological Symptoms of Sarcoidosis
Sarcoidosis affects the eyes in about 25 percent of cases. Its most common manifestation is inflammation, a common disorder that is rarely due to sarcoidosis. Usually patients complain of blurred vision in both eyes, sensitivity to bright light, excessive tearing, or pain. In chronic sarcoidosis, more serious eye problems can develop, such as glaucoma and cataracts. If left untreated, sarcoidosis can lead to blindness.