Extrapulmonary manifestations of sarcoidosis

Abstract

Sarcoidosis is a systemic disease characterized by the development of epithelioid granulomas in various organs. Although the lungs are involved in most patients with sarcoidosis, virtually any organ can be affected. Recognition of extrapulmonary sarcoidosis requires awareness of the organs most commonly affected, such as the skin and the eyes, and vigilance for the most dangerous manifestations, such as cardiac and neurologic involvement. In this article, the common extrapulmonary manifestations of sarcoidosis are reviewed and organ-specific therapeutic considerations are discussed.

Fig. 1

Examples of cutaneous sarcoidosis. (A) Waxy papules over the eyelid of a patient with systemic sarcoidosis. (B) Granulomatous inflammation within the area of 1 color of a tattoo in a patient with systemic sarcoidosis. (Courtesy of Dr J. Merola, Brigham and Women’s Hospital, Boston, MA.)

Fig. 2

Examples of ocular sarcoidosis. (A) Scleritis in a patient with sarcoidosis. (B) Optic nerve swelling on fundoscopic exam. (Courtesy of Dr G. Papaliodis, Massachusetts Eye and Ear Infirmary, Boston, MA.)

Fig. 3

Examples of neurosarcoidosis. (A) Orbital and dural involvement (arrow) on gadolinium-enhanced T1-weighted fat-saturated MRI. (B) Diffuse nodular meningeal lesions on gadolinium-enhanced T1-weighted fat-saturated MRI. (C) Involvement of the pituitary infundibulum (arrow) on gadolinium-enhanced T1-weighted fat-saturated MRI. (D) Involvement of the foramen of Magendie (arrow) causing hydrocephalus. (Courtesy of Dr K. Talekar, Thomas Jefferson University Hospital, Philadelphia, PA.)

Fig. 4

Examples of musculoskeletal involvement in sarcoidosis. (A) Punched-out cortical lesions and coarsened trabeculae yield a characteristic lacelike pattern in the proximal, middle, and distal phalanges. (B) Focal targetlike lesions in the vertebral bodies seen on sagittal short-tau inversion recovery sequence MRI. (C) Multiple large, lytic lesions within the skull of a patient with sarcoidosis. (D) Lobular lesions (arrow) within the vastus medialis muscle on gadolinium-enhanced MRI. (Courtesy of [A, C, D] Dr S. Smith, Brigham and Women’s Hospital, Boston, MA; and [B] Dr K. Talekar, Thomas Jefferson University Hospital, Philadelphia, PA.)