Arthritis and Rheumatism Associates, P.C.

Nicole Saddic Thomas, MD, FACRNicole Saddic Thomas, MD, FACR

A 40-year-old gentleman came to me complaining of fevers, night sweats,10 pounds unintentional weight loss, and swollen ankles. He had high calcium levels and very high levels of inflammation noted on his blood tests. There were no clear-cut infections to account for the inflammation. To investigate further, I obtained x-rays, which revealed many swollen lymph nodes in his chest. I was concerned about malignant cancer and consulted with hematology/oncology colleagues who shared my concern. We arranged a lymph node biopsy and, fortunately, there was no cancer found. What the lymph node biopsy report did reveal was “sarcoidosis.”

Sarcoidosis is an autoimmune condition that causes the body to form nodules consisting of inflamed tissue, called granulomas, in the body’s organs. Sarcoidosis can affect almost any organ in the body. It usually involves the lungs, but the skin, eyes, nose, muscles, heart, liver, spleen, gut, kidney, nerves, lymph nodes, joints, and brain can all be involved.

We do not know the exact cause of sarcoidosis. The prevailing theory is that there is an environmental trigger in a genetically susceptible person that leads to the development of the disease. Sarcoidosis is not contagious and is more common in African-American, German, Irish, Scandinavian, Asian and Puerto Rican patients. Sarcoidosis generally occurs between the ages of 20 and 40 but can be diagnosed at any age.

Because sarcoidosis can affect so many different organs, it can be challenging to diagnose. The symptoms also may vary depending on the organs involved. Some people may have no symptoms and sarcoidosis only becomes apparent when a routine chest X-ray comes back as abnormal, showing evidence of lymph node swelling from sarcoid involvement. Other patients may experience weight loss, fatigue and fevers. If the lungs
are involved, coughing, breathlessness or chest pain may occur. Patients may experience painful, red eyes or vision loss if sarcoidosis involves the eyes. Skin nodules, ulcers or flat areas of discolored skin can develop in sarcoidosis patients, usually near the nose or eyes, or on the back, arms, legs and scalp. Tender bumps also may appear on the ankles and shins. Sarcoidosis can cause swollen cheeks and dry mouth. It also can cause swollen lymph nodes, sometimes occurring within the chest, but also may occur under the chin, in the armpit area or in the groin. Sarcoidosis also may cause elevated calcium levels or abnormal blood cell counts. Rarely, sarcoidosis may interfere with the heart’s electrical system and cause irregular heart rhythms or affect the brain or nerves causing
neurological dysfunction.

There is no single test to diagnose sarcoidosis and its diagnosis generally depends on the organ system involved. Imaging studies, especially a chest x-ray, can be helpful. A blood test called an ACE (angiotensin converting enzyme) level is used to determine elevated levels related to sarcoidosis. However, it is possible to have sarcoidosis with a normal ACE test and ACE levels also can be elevated due to other conditions, so it’s not a perfect test. If possible, a biopsy of the swollen area is ideal to confirm a diagnosis of sarcoidosis and rule out other causes of swelling such as infections, cancers or other medical conditions.

Because sarcoidosis can affect so many different organs, it can be challenging to diagnose. The symptoms also may vary depending on the organs involved. Some people may have no symptoms and sarcoidosis only becomes apparent when a routine chest X-ray comes back as abnormal, showing evidence of lymph node swelling from sarcoid involvement. Other patients may experience weight loss, fatigue and fevers. If the lungs are involved, coughing, breathlessness or chest pain may occur. Patients may experience painful, red eyes or vision loss if sarcoidosis involves the eyes. Skin nodules, ulcers or flat areas of discolored skin can develop in sarcoidosis patients, usually near the nose or eyes, or on the back, arms, legs and scalp. Tender bumps also may appear on the ankles and shins. Sarcoidosis can cause swollen cheeks and dry mouth. It also can cause swollen lymph nodes, sometimes occurring within the chest, but also may occur under the chin, in the armpit area or in the groin. Sarcoidosis also may cause elevated calcium levels or abnormal blood cell counts. Rarely, sarcoidosis may interfere with the heart’s electrical system and cause irregular heart rhythms or affect the brain or nerves causing neurological dysfunction.

Some people with sarcoidosis require no treatment. If the inflammation is leading to organ damage, corticosteroid medications and sometimes further immunosuppressant medications are needed. Your rheumatologist can help you test for sarcoidosis and determine the best course for you.

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