Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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Sarcoidosis can present in many ways, depending on which organs are affected and how severe the inflammation is. Some people have no symptoms and only find out they have the disease from a chest X-ray done for another reason. Others may have sudden, severe symptoms that need hospital care. Knowing the risk factors and possible symptoms is important for early diagnosis. At Liv Hospital, we carefully review all symptoms, as problems with the skin or eyes can appear before or alongside lung symptoms.
Since the lungs are the most frequently affected organ, respiratory symptoms are the cornerstone of the clinical picture in sarcoidosis
The most common complaint is a persistent, dry cough without sputum production. This is caused by the granulomas irritating the airways and lung tissue. As the disease progresses and granulomas take up more space or cause scarring (fibrosis), patients experience shortness of breath (dyspnea). Initially, this may only occur with exertion, but in advanced pulmonary sarcoidosis, it can be present even at rest.
Some patients experience vague chest pain, tightness, or discomfort. This is often described as a heaviness in the chest. Wheezing can also occur if granulomas or enlarged lymph nodes compress the airways, or if there is endobronchial involvement (granulomas within the airways). These symptoms can sometimes be mistaken for asthma.
Sarcoidosis causes inflammation throughout the body, leading to widespread symptoms that can be very difficult to manage.
Fatigue is one of the most common and distressing symptoms of sarcoidosis, affecting a significant majority of patients. It is not merely tiredness but a profound lack of energy that is not relieved by sleep. This fatigue can persist even when the granulomatous inflammation is controlled, significantly impacting quality of life.
Mild fever and night sweats are common, especially when the disease first appears or during flare-ups. Many people also lose weight because the body uses more energy due to ongoing inflammation.
Cutaneous Sarcoidosis Symptoms
The skin is the second most common organ affected by sarcoidosis, and skin changes can be a clear sign that the disease is active.
This is a hallmark of acute sarcoidosis. It presents as tender, red, painful nodules, usually on the front of the lower legs (shins). It is often accompanied by fever and joint pain, a triad known as Löfgren’s syndrome.
Lupus pernio is a specific type of chronic cutaneous sarcoidosis characterized by indurated, purple or violaceous lesions on the nose, cheeks, lips, and ears. It is often associated with more severe, chronic systemic disease. Other skin manifestations include maculopapular eruptions, subcutaneous nodules, and infiltration of old scars (scar sarcoidosis), where previously healed scars become raised and red.
Lupus pernio is a specific type of chronic cutaneous sarcoidosis characterized by indurated, purple or violaceous lesions on the nose, cheeks, lips, and ears. It is often associated with more severe, chronic systemic disease. Other skin manifestations include maculopapular eruptions, subcutaneous nodules, and infiltration of old scars (scar sarcoidosis), where previously healed scars become raised and red.
Ocular and Visual Symptoms
Ocular sarcoidosis is involved in a significant proportion of patients, and untreated ocular sarcoidosis can lead to blindness.
Uveitis, or inflammation of the middle layer of the eye, is the most common ocular manifestation. Symptoms include blurred vision, eye pain, redness, and photophobia (sensitivity to light). Sarcoidosis can involve the eyes, presenting as dry eyes (sicca syndrome) or conjunctival nodules.
In severe cases, sarcoidosis can affect the optic nerve, leading to vision loss. Since eye problems may not cause symptoms at first, regular eye exams are important for everyone with sarcoidosis.
Cardiac Sarcoidosis Symptoms
When sarcoidosis affects the heart, it can be very serious and is among the most dangerous manifestations of the disease.
Granulomas can infiltrate the heart’s electrical conduction system, causing heart blocks (where the electrical signal is slowed or stopped) or dangerous ventricular arrhythmias. This can lead to palpitations, dizziness, fainting (syncope), or even sudden cardiac death.
Extensive infiltration of the heart muscle (myocardium) can weaken the heart’s pumping ability, leading to congestive heart failure. Symptoms include leg swelling, orthopnea (shortness of breath when lying flat), and severe fatigue.
Neurosarcoidosis Symptoms
When sarcoidosis involves the nervous system, it is called neurosarcoidosis
The most common manifestation is facial nerve palsy, which causes drooping of one side of the face (Bell’s palsy). It can be bilateral. Other cranial nerves can be involved, affecting hearing, swallowing, or eye movement.
Granulomas can form in the brain or spinal cord, leading to seizures, headaches, cognitive changes, meningitis, or weakness and numbness in the extremities due to peripheral neuropathy.
Musculoskeletal Symptoms
Joint and bone involvement contributes significantly to the burden of pain.
Joint pain (arthralgia) and inflammation (arthritis) are common, particularly in the ankles and knees. This is often seen in conjunction with erythema nodosum in acute sarcoidosis.
In rare cases, sarcoidosis can cause cysts in the bones, especially in the fingers and toes, which leads to swelling and pain.
Calcium Metabolism Disorders
Granulomas in sarcoidosis can make active Vitamin D.
The granulomas produce an enzyme that converts Vitamin D to its active form, increasing calcium absorption. This leads to high levels of calcium in the blood (hypercalcemia) and urine (hypercalciuria), which can cause kidney stones and, if untreated, kidney failure. Symptoms include excessive thirst, frequent urination, and confusion.
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CT scans use X-rays to create detailed cross-sectional images and are excellent for visualizing kidney stones, detecting tumors, and evaluating traumatic injuries. They are fast and widely available. MRI uses strong magnetic fields and radio waves to produce detailed images of soft tissues, making it superior for staging prostate cancer, evaluating bladder wall invasion, and assessing pelvic floor disorders without ionizing radiation.
Contrast dye, usually iodine-based, is injected into a vein to highlight the blood vessels and urinary tract organs. As the kidneys filter the dye from the blood, it opacifies the urine. This allows the radiologist to see the internal structure of the kidneys, the ureters, and the bladder clearly, revealing blockages, tumors, or structural abnormalities that would be invisible on a non-contrast scan.
Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.
CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.
Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.
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