Sarcoidosis in the western region of Saudi Arabia

To review a general hospital's experience with sarcoidosis and the clinical pattern of the disease among the Saudis.

Retrospective file review was carried out of all patients with proven diagnosis of sarcoidosis in a general hospital in Western Saudi Arabia over a period of 11 years (1985-1996).

Twenty-one patients, of whom 17 were native Saudis, had been diagnosed to have sarcoidosis during the study period. There were 5 males and 16 females. The mean age was 45 years with a range of 20-69 years. The commonest presentations were cough (43%), dyspnoea (43%), joint pain (38%), hepatomegaly (29%), splenomegaly (24%) and lymphadenopathy (24%). The biochemical analysis showed raised alkaline phosphatase in 66%, calcium level was elevated in 5% and urinary calcium was elevated in 3 out of 7 patients tested. Angiotensin Converting Enzyme was elevated in 11 of 15 patients. Tuberculin test was negative in all those tested (17 patients). The patients were classified using the Siltzbach staging into 0-3. Stage 0 (14%), Stage 1 (33%), Stage 2 (43%) and Stage 3 (10%). The gallium scan was positive in 90% of those who were tested (7 patients). The diagnosis in all except one patient was proven histologically. The outcome was favourable in most patients (76%), though 52% received active treatment.

Sarcoidosis does occur in native Saudis. On comparison with Western patterns of the disease, there is a female predominance and relative lack of cardiac, eye, parotid and central nervous system involvement. The rarity of cardiac and central nervous system involvement was comparable with other Middle Eastern studies. Sarcoidosis, though rare in our community, should still be considered in the differential diagnosis of patients with the typical presentation after excluding tuberculosis which is epidemic.