What is Sarkoidosis

Common systemic granulomatous disease of unknown cause Sarkoidosis are placed in the pulmonary infiltrates. The main places to be seen in lung and intrathoracic lymph nodes.

Mediastinum, hilar and perihilar lymph nodes, lung, liver, spleen, skin, eyes, phalangeal bones, and parotid glands are the organs that the disease most chosen. Sarcoidosis is found in almost every country. However, Scandinavia, Britain and the United States are at an increased. 5-10/100.000 incidence is.

Turkey is a rare disease with increasing frequency monitored. Men, women, blacks and whites, 30-40 years of age are more numerous, but can be seen at any age.

Sarcoidosis Etiology

Sarcoidosis is a definite cause of disease to be determined.
Some genetic, immunological problems, the effects of a growing assumption in the etiology of the disease.
Incidence of sarcoidosis in some areas, people have a lot of families, and supports this hypothesis.


About 90% of cases of sarcoidosis in lung and hilar lymph nodes loka-lize. Other organs also settles. Casein-Fi histopathological feature of the disease, non-necrotic granulomatous inflammatory tissue reaction. Sometimes it may occur less caseation qualifications. Epithelioid cell granuloma, or tubercle Langhans giant cells and inclusion bodies found in the nature of the tissue. Pathognomonic for this disease is not seen in sarcoidosis epithelioid tubercles. Other diseases such as tuberculosis, diseases and Hodgkin'de fiıngus can be seen.

Clinical symptoms of Sarcoidosis

Clinical symptoms and general symptoms often related to the localization of other organs. For example akut.dönemde approximately 30% of cases seen in erythema nodosum. Fatigue, anorexia, weight loss, fatigue and general symptoms such as fever sübfebril often insidious nature. All of these symptoms are not together. For example, 50% of fever cases are observed.

Lung symptoms

Clinical symptoms of the respiratory system depends on the particular formation of lung parenkimasında inifiltrasyonunun. Pulmonary symptoms such as dry cough and dyspnea seen in 25% of cases. Hemoptysis is rare. Physical examination, there is a glimpse of the early stages of the disease.

Depending on the degree of localization of the disease and sibilan, ronflan and age Railer be heard.

75% of patients with peripheral lymphadenopathy in sarcoidosis has LenfadenopatL. Most hilar and paratracheal lymphadenopathy is seen in the region. This adenopa-depressive symptoms often bilateral and symmetrical.

Eye lesions. Characteristic eye lesions, uveitis. Seen in 25% of cases. Conjunctiva, sclera, retina, the lesion may be.

Skin lesions. Nodozumdur one characteristic erythema, temporary nature and usually occurs in the lower extremities. In some cases of acute sarcoidosis, erythema nodosum, fever, arthralgia, and hilar lymphadenopathy are with. The front faces of the legs tight, bright red nodules typical lesion of erythema nodosum usually bilateral. Arm, calf and can be found in the body.
The nodules appear suddenly, but slowly heal. Recovered before the tension is reduced erythema, dark ecchymotic consists of a color, and then heal without leaving a trace or no complication.
Erythema nodosum is a skin lesion is not specific for sarcoidosis. Tuberculosis, kolagen disease, ulcerative colitis, bacterial, viral and fungal infections and drug-ment may be related to a reaction. For example, sulfonamide, iodine, bromide, tetracycline and oral contraceptives can create erythema nodosum.

Liver and spleen lesions. Biopsy and autopsy cases, 75% of the lesions of sarcoidosis are the liver and dalakda. However, such a possibility with the clinical examination in 25% of cases are observed.

Bone and joint lesions. Especially the large joints such as knees, ankles and mono-or polyarticular arthritis symptoms observed in acute or chronic nature. In these cases, granulomatous sarcoid-lomasım sinovia membrane biopsy shows. Hands and feet of cystic bone lesions, such as the terminal falankslarında staple holes for a typical finding in sarcoidosis, but 5% of cases seen in these lesions.

Lesions of salivary glands. 5% of cases in the parotid, sublingual glands and submaksiler husule asimptomatik revenue growth. However, the growth of mumps parotid painful.

Growth of salivary glands, glands in some cases, the growth of eye, uveitis, and fever that accompany it are called uveoparotid fire.

Kidney and heart complications of sarcoidosis, or can be monitored.

Lezyonlaru different nature of the nervous system, most commonly seen facial paralysis. One way or bilateral, often heal spontaneously.

Radiological findings. In the case of about 90% of intrathoracic sarcoidosis lesions have the radiological examination in the diagnosis of disease is important. In the bilateral hilar adenopathy with right paratracheal adenopathy is a common finding.

Sarkoidosis Laboratory

Sarcoidosis is a two-thirds of patients with late skin reactions, for example, tuberculin skin test (PPD) was negative. TEMPERATURE circulating T lymphocytes are closely related to a reduction in skin anergy.
In most patients, increased sedimentation rate. Electrophoresis of serum gamma and beta fraction of 50% of cases are seen hyperglobulinemia.

Kveim test in sarcoidosis cases 2 / 3 'in the positive. For this test, spleen or lymph nodes of patients with human sarcoidosis tissue suspension (antigen) is injected into the skin. Papulonodular granulomatous lesion develops 4-6 weeks after the examination of tissue necrosis seen in non-positive for the diagnosis of sarcoidosis. However, the standard for a long time to wait for the result of people have power because of antigen Kveim test increasingly applied to a lesser extent.

And angiotensin converting enzyme in lung tissue retention Galium'un (ACE) tests are tests to help. These tests and the Kveim test is not specific qualifications.

Lung function tests

Pulmonary function abnormalities increases with increasing infiltration of lung parenkimasında sarcoidosis. These abnormalities are usually restrictive nature: vital capacity, diffusion capacity and compliance is reduced. Hypoxemia at rest and after exertion before the more advanced stages of the disease occurs. Diffusion capacity is an important test for the evaluation of treatment effect and prognosis.


Two findings are important for diagnosis: 1 Clinical and radiological findings, in accordance with the non-granulomatous lesions kazeifıkasyonu. 2. Of granulomatous inflammation in the absence of other diseases.
Direct biopsy of lymph nodes or tissues obtained by bronchoscopy or medias-tinoskopide non-caseating granulomatous tissue appearance of sarcoidosis is diagnosed. These biopsies are negative, liver biopsy may be helpful in diagnosis.

Bronchoalveolar lavage (BAL), a finding in accordance with the high rate of diagnosis of the disease seen in lymphocytes.

Treatment and prognosis

Asymptomatic patients do not need treatment. There is no cure for sarcoidosis spesiifık. However, to prevent and reduce disease activity in corticosteroid has no effect. Corticosteroid treatment indications: 1 Active eye lesions, 2.İlerleyici lung lesions, 3 Persistent hypercalcemia or hiperkal-siüri, 4 Central nervous system lesions and functional abnormalities of the 5th Fever, systemic symptoms such as weight loss, 6 Significant cardiovascular abnormalities.

Start with 40-50 mg daily prednisone therapy. 2 weeks after the drug every 2 days by reducing 5 mg, 30 mg / day for 2 weeks of treatment is continued. And then in the same way by reducing the 10-20 mg / day prednisone maintenance dose is applied. Prednisone therapy improves clinical symptoms in 1-2 weeks. A few months after the disease will decline. Corticosteroid therapy should continue for at least 6 months. The dose and duration of improvement in chest radiographs, pulmonary function and systemic symptoms, according to the set. In some cases, healing occurs 12-18 months, in some cases take longer. In some cases, good results can be taken with a maintenance dose every other day.

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