As sarcoidosis can appear in any organ within the body, it often mimics other diseases, and is sometimes misdiagnosed. Patients can present with a variety of symptoms, and can experience more than one type of sarcoidosis at a time.
Calcium metabolism
Irregular calcium metabolism is experienced by many sarcoidosis patients, and some are affected with hypercalciuria which is elevated levels of calcium in the urine. Fewer patients develop hypercalcemia, which is high calcium levels in the blood. Hypercalcemia is usually asymptomatic, and symptomatic hypercalcemia is seen in fewer than five percent of patients.
Calcium metabolism is caused by elevated serum calcium levels. Kidney stones may result from abnormal calcium metabolism.
Cardiac sarcoidosis
Cardiac sarcoidosis affects the heart and is found among approximately one-third of sarcoidosis patients, with only five percent experiencing symptoms. The granulomas interfere with the electrical signals that trigger the contraction of the heart muscle and can manifest as advanced heart block, arrhythmias (irregular heart beats), and congestive heart failure.
Cutaneous sarcoidosis
Cutaneous sarcoidosis affects the skin, andoccurs in approximately 20 to 35 percent of patients.
- Erythema nodosum causes painful red lumps on the lower arms, legs, or shins. It is often accompanied by Lofgren syndrome which involves arthritis in the ankles, elbows, wrists, and hands.
- Lupus pernio is a painful bluish-red, purple discoloration of nodules of the skin found on the face, ears, fingers, or toes.
- Lesions vary in severity and can be lumps or rashes located on the extremities, face, scalp, back, and buttocks.
Musculoskeletal sarcoidosis
Musculoskeletal sarcoidosis affects the bones, muscles, and joints. It can present as arthritic like symptoms, and inflammation of the joints and surrounding tissues. Symptoms include the swelling and tenderness of the lower legs, ankles, knees, and fingers.
Löfgren’s syndrome is an acute form of arthritis found in sarcoidosis patients. It presents as swelling of the joints and painful bumps on the shins referred to as erythema nodosum.
Chronic arthritis is more severe, and can affect the ankles, feet, knees, wrists or hands. Treatment is recommended to prevent permanent damage to the joints.
Sarcoidosis may also affect bone density, which can also be a side effect of prednisone and corticosteroid treatment. A loss of bone density can result in an increased risk of fractures should bones weaken.
Approximately 50 – 80 percent of patients will develop granulomas in the muscle. In rare instances, for approximately one percent of cases, granulomas can build up within muscles to form a painful tumor-like lump that can compress and damage surrounding muscle tissue.
Hepatic sarcoidosis
Hepatic sarcoidosis involves granulomas in the liver. Liver involvement is common in sarcoidosis occurring in approximately 70 percent of patients; with most cases being asymptomatic. Some patients may experience fever, abdominal pain, weight loss, enlargement of the liver, changes in the liver enzyme levels, jaundice, malaise, and fatigue.
Neurosarcoidosis
Neurosarcoidosis affects 5 to 15 percent of patients. This form of sarcoidosis occurs when granulomas develop in and around the central nervous system, which encompasses the brain, spinal cord, and optic nerve. The inflammation from the granulomas can destroy the coating that surrounds and protects nerve fibers resulting in the disruption of the normal flow of nerve impulses from the central nervous system; ultimately, causing a reduction or loss of body function.
Neurosarcodiosis is rare, but can be severe and debilitating. It generally affects the cranial and facial nerves, the hypothalamus area of the brain, and the pituitary gland. Symptoms vary depending on the areas of the central nervous system that are affected.
Pituitary gland symptoms may include:
- Fatigue
- Changes in menstrual cycle
- Excessive urination
- Excessive thirst
Brain or cranial involvement symptoms may include:
- Confusion, disorienttion
- Hearing loss
- Dementia
- Delirium
- Dizziness, vertigo, or abnormal sensations of movement
- Vision problems
- Facial palsy
- Headache
- Loss of sense of smell
- Loss of sense of taste, abnormal tastes
- Psychiatric disturbances
- Seizures
- Speech impairment
Peripheral nerve involvement symptoms may include:
- Muscle weakness
- Numbness or tingling sensations
- Loss of movement
Ocular sarcoidosis
Ocular sarcoidosis affects the eyes and is common, occurring in approximately 50 percent of sarcoidosis patients. Ocular sarcoidosis can involve any part of the eye and its tissues. Symptoms may include uveitis, eyelid abnormalities, conjunctival granuloma, optic neuropathy, lacrimal gland enlargement, and orbital inflammation. Patients should seek treatment to avoid major complications such as cataracts or glaucoma.
- Uveitis is the most common diagnosis, and can cause pain, redness, swelling, and vision problems.
- Granulomas can form in the eyelids causing abnormalities.
- Conjunctival granulomas, painful lesions in the eye, are rare.
- Optic neuropathy is damage to the optic nerve of the eye.
- Lacrimal glands are the tear producing glands located above each eyeball. If inflamed, it can lead to discomfort of the area near the eye ducts, dry eyes, excessive discharge or tearing, inflammation of the outer upper lid, pain, and inflammation.
- Symptoms of orbital inflammation include the sudden pain, swelling, and reddening of the eyelids.
Pulmonary sarcoidosis
Pulmonary sarcoidosis is the most common type of sarcoidosis and affects the lungs. Granulomas, or small lumps of inflammatory cells, can form in the lungs; thereby affecting lung function which can lead to shortness of breath, a persistent dry cough, chest pains, and wheezing. If the inflamed lung tissue doesn’t heal, it can cause scarring and permanent damage to the lungs. In rare cases bronchiectasis occurs, which is the infection of the air tubes of the lungs. Generally, the granulomas in the lungs heal and disappear on their own.
Renal sarcoidosis
Renal sarcoidosis is characterized by the formation of granulomas in the kidney, and occurs in 35 – 50 percent of patients. Patients should seek treatment to avoid kidney failure. The granulomas can produce an enzyme which can result in elevated calcium levels in the blood and urine which can lead to dehydration, and the development of kidney stones. In rare cases kidney failure may occur.
Sarcoidosis in the salivary glands
Sarcoidosis in the salivary glands presents with a painless and persistent enlargement of the parotid glands. The parotid glands are two salivary glands situated in front of each ear. Patients often present with dry mouth, or xerostomia, where the salivary glands don’t produce enough saliva to keep your mouth wet. Otolaryngologic manifestations are seen in 10 — 15 percent of sarcoidosis patients.
Sarcoidosis of the sinuses
Sarcoidosis of the sinuses has been reported in approximately 1 – 38 percent of sarcoidosis cases. Patients with sarcoidosis nasal involvement have presented with symptoms of nasal crusting, congestion, bleeding from the nose, pain, the loss of the sense of smell, the lining of the nasal cavity is easily torn, and nasal polyps. Most patients experiencing sarcoidosis of the sinuses have abnormal sinus x-rays with either thickening of the lining of the nasal cavity or inflammation of the sinuses.
Sarcoidosis of the spleen and bone marrow
Sarcoidosis of the spleen and bone marrow occurs with the formation of granulomas in those specific organs. It has been reported that 34 percent of patients experience sarcoidosis of the spleen, and 10 percent experience bone marrow involvement.
Bone marrow is the spongy tissue found in the center of some of our large bones and contains stem cells. The stem cells produce red blood cells that transport oxygen throughout the body, and white blood cells that fight infection.
The primary function of the spleen is to filter the blood. The spleen also stores platelets and white blood cells. The spleen plays a very important role in the immune system; however, it is possible to live without it. The spleen is soft, looks purple, and is located under the ribcage, above the stomach in the left upper quadrant of the abdomen.
Spleen or bone marrow sarcoidosis may lead to anemia, leukopenia, and thrombocytopenia.
- When there aren’t enough red blood cells to transport oxygen throughout the body, anemia occurs.
- White blood cells are an important part of the immune system. Leukopenia is a low white blood cell count which makes it difficult for the body to fight off diseases and infections.
- Thrombocytopenia is characterized by abnormally low levels of platelets in the blood. When there are insufficient platelets in the blood, the body cannot form clots, which can lead to excessive bleeding.