Sarcoidosis

Etiology • Unknown; granulomatous disease process • May represent a systemic response to a single provoking agent;
mycobacteria has been suggested but not proven • Possible role of genetic factors coupled with disordered reac-
tions to foreign antigens
Clinical Presentation • Mucocutaneous
• Red to brown nodules/plaques with erythema nodosum features
• Minor salivary glands of the lips and palate may be involved. • Erythematous, hyperplastic gingiva
• Salivary/lacrimal • Parotid, submandibular, and lacrimal glands may be
enlarged. • Multiple organ systems, such as the following, may be involved:

• Particularly the lung, but also liver, endocrine glands, the heart, and the reticuloendothelial and musculoskeletal systems
• Heerfordt’s syndrome may be related to sarcoidosis (uveitis, parotid gland enlargement, fever, cranial nerve palsies).
Diagnosis • Demonstration of sarcoidal (noncaseating epitheloid) granulo-
mas in at least two organ systems • Elevated serum angiotensin-converting enzyme levels are
usually present. • Over 90% of cases have abnormal chest radiograph. • Other causes of granulomatous inflammation must be ruled out.
Differential Diagnosis • Tuberculosis • Lymphoma (non-Hodgkin’s, Hodgkin’s) • Deep fungal infection • Crohn’s disease

Treatment • Corticosteroids, if symptoms demand • Severe or unresponsive cases: methotrexate • Cutaneous lesions only: hydroxychloroquine • Intralesional corticosteroids
Prognosis • Generally good