26th February 2025

Clinical features of sarcoidosis

Sarcoidosis is a multisystem inflammatory disorder characterised by non-caseating granulomas on histology. 

Acute sarcoidosis (Löfgren’s syndrome) classically presents with a triad of erythema nodosum, fever and bilateral hilar lymphadenopathy. These features are not always all present, and polyarthritis is also commonly seen. It is generally self-limiting, and lymphadenopathy tends to resolve within 1 year.

Chronic sarcoid is more variable and can affect almost any organ system. Lung disease is the most common manifestation, either as bi-hilar lymphadenopathy or, at later stages, as pulmonary fibrosis. The most classic skin involvement is lupus pernio, a violaceous plaque or nodules that affects the nose, cheeks and ears. Cardiac and neurological involvement has a poor prognosis of up to 25% mortality. Granulomas can be found anywhere, including liver, kidneys, and GI tract; however, symptoms are generally caused by release of mediators, not the granulomas themselves.