Treatment of pulmonary sarcoidosis: a practical guide

More than a century ago, Jonathan Hutchingson, a surgeon-dermatologist, identified the first case of sarcoidosis at King's College, London. The disease is now known as a commonplace multi-system disorder characterised by the formation of noncaseating granulomata. The diagnosis of sarcoidosis is established by recognising clinicoradiological findings and providing histological evidence of noncaseating granuloma. Serum angiotensin converting enzyme levels are high in about two-thirds of the patients and hypercalcaemia is a feature in 1 of every 10 patients with sarcoidosis. Immunological abnormalities include depression of cutaneous delayed-type hypersensitivity, hyperactive B cells and the presence of circulating immune complexes. The course and prognosis of the disease usually correlate with the mode of onset. An acute onset with erythema nodosum indicates a good prognosis and spontaneous resolution, whereas an insidious onset may be followed by relentless, progressive fibrosis. Mortality and morbidity are caused by pulmonary fibrosis, cardiac arrhythmias, renal failure, neurological involvement and blindness. Corticosteroids and choloroquine relieve symptoms and suppress inflammation and granuloma formation.