Review Question - QID 103628

This patient presents with progressive dyspnea, symptoms of anterior uveitis, hypercalcemia, and bilateral hilar lymphadenopathy consistent with sarcoidosis. Symptomatic sarcoidosis should be treated with oral corticosteroids.

Pulmonary symptoms of sarcoidosis include exertional dyspnea and dry cough. Roughly 25% of cases have eye involvement. Anterior uveitis is the most common eye pathology and manifests as photophobia and blurry vision. Patients with active lung disease or severe skin or eye involvement should be treated with systemic corticosteroids.

Wu and Schiff review sarcoidosis and note that diagnosis centers around clinical history, radiographic findings, and histologic evidence of noncaseating epithelioid granulomas. Topical steroids are used for uveitis and skin lesions and systemic steroids are used for cardiac, pulmonary, and CNS involvement. For progressive sarcoid, methotrexate is the most utilized immunomodulator, largely because of its safety profile and because it is steroid sparing. End-stage disease can require organ transplantation.

Umur et al. review the opthalmological manifestations of sarcoidosis. The disease may present as bilateral optic neuropathy, Horner's syndrome, pars planitis, and anteriorand posterior uveitis.

Figure A demonstrates bilateral hilar lymphadenopathy on chest X-ray, a classic feature of sarcoidosis.

Incorrect Answers:
Answer 1: Furosemide may be used for symptomatic relief in volume overloaded states of congestive heart failure or to help remove excess calcium in patients with hypercalcemia. It has no role in sarcoidosis.
Answer 3: Calcitonin can be used to treat severe, acute hypercalcemia. It is not used in the management of sarcoidosis.
Answer 4: Methotrexate is used in progressive sarcoidosis refractory to corticosteroids.
Answer 5: Most cases of sarcoidosis resolve spontaneously. Asymptomatic patients do not require treatment.