Sarcoidosis

Sarcoidosis is a granulomatous condition that most commonly affects the lungs and lymph nodes in the chest, though it can involve almost any organ. Presentations range from mild, self-limiting disease to chronic pulmonary involvement and, in a minority of patients, progressive lung fibrosis. Dr Mackintosh assesses and manages pulmonary sarcoidosis, including complex and fibrotic disease, for patients across Brisbane and Queensland.

Diagnosis

Diagnosis is based on a compatible clinical and radiological picture — typically bilateral hilar and mediastinal lymphadenopathy, with or without lung nodules or infiltrates on HRCT — supported by histopathology showing non-caseating granulomas, usually obtained via bronchoscopy and endobronchial ultrasound (EBUS)-guided lymph node sampling. An important part of assessment is excluding other causes of granulomatous inflammation, including infection such as tuberculosis. Where extrapulmonary involvement is suspected — such as cardiac or neurological symptoms — assessment is coordinated with the relevant specialists.

Management

Many people with sarcoidosis have mild disease that can simply be monitored. Where treatment is needed, a variety of treatment options are considered. In a minority of patients, sarcoidosis progresses to lung fibrosis, which may need a different treatment approach — see progressive pulmonary fibrosis.

Patient information

Sarcoidosis — fact sheet, Lung Foundation Australia.
What Is Sarcoidosis? and Treatment of Sarcoidosis — patient education series, American Thoracic Society.

Frequently asked questions

What is sarcoidosis?

Sarcoidosis is a condition in which small clusters of inflammatory cells called granulomas form in one or more organs, most commonly the lungs and lymph nodes in the chest, though it can also affect the skin, eyes, heart, nervous system and other organs. Its exact cause is not fully understood.

Does sarcoidosis always need treatment?

No. Many people with sarcoidosis have mild or no symptoms and are simply monitored over time, as the condition can improve or resolve on its own. Treatment is generally reserved for those with significant symptoms, declining organ function, or involvement of higher-risk organs such as the heart or nervous system.

Can sarcoidosis cause permanent lung scarring?

In most people, pulmonary sarcoidosis does not progress to lung scarring. In a minority, ongoing inflammation leads to pulmonary fibrosis, which can behave as a progressive fibrosing disease requiring a different treatment approach, including antifibrotic therapy in some cases.

For referring clinicians

Dr Mackintosh welcomes referrals for assessment of suspected or confirmed pulmonary sarcoidosis, including complex, refractory or fibrotic presentations.

Referral information