Practical issues and challenges in the diagnosis and treatment of pulmonary sarcoidosis

Sarcoidosis is a granulomatous disease with multisystem involvement. Diagnosis is generally easy to establish from the characteristic clinical and radiographic features. In India and other developing countries, tuberculosis is the closest clinical mimic and needs to be excluded before therapy for sarcoidosis is instituted. Tuberculin anergy and histopathological demonstration of characteristic compact granulomas help in the diagnosis of sarcoidosis. Corticosteroids constitute the mainstay of therapy for symptomatic pulmonary and most other forms of extrapulmonary sarcoidosis. Asymptomatic disease does not require any treatment, but milder forms may be treated with topical corticosteroids and symptomatic therapy. Alternative drugs such as cytotoxic agents, hydroxychloroquine and other agents are used either alone or in combination for the treatment of relapses and recurrences and refractoriness or in the presence of complications of corticosteroids. Treatment is usually continued for about a year, but it may need to be prolonged in patients with disease that persists and the response to therapy is delayed.