The Diagnosis, Differential Diagnosis, and Treatment of Sarcoidosis

Background: Sarcoidosis is a granulomatous inflammatory disease of unknown cause. Its prevalence in Germany is approximately 46 per 100 000 persons. Methods: This article is based on pertinent publications retrieved by a selective search in PubMed. Results: A presumptive diagnosis of sarcoidosis is made in any patient with a granulomatous inflammation that is not explained by any other identifiable cause, such as an infection or foreign body. Non-caseating granulomas containing epithelioid cells are its histological hallmark. Recently developed diagnostic techniques, including positron emission tomography and magnetic resonance imaging, have made it easier to detect organ involvement and to assess the activity of the disease. The pattern of organ involvement varies from patient to patient. Many patients have a systemic inflammatory reaction with sub-febrile or febrile temperatures, night sweats, weight loss, diminished physical reserve, and fatigue. Sarcoidosis often resolves spontaneously. Detection of organ involvement is not necessarily an indication for treatment, but treatment is clearly needed if there is symptomatic cardiac involvement or any involvement of the central nervous system. Oral corticosteroids are the first line of treatment. Their long-term use can cause serious complications. Conclusion: The treatment of patients with sarcoidosis, particularly those with complicated disease courses, requires close collaboration of the primary care physician with a specialized interdisciplinary center.