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Clinical Profile and Outcome of Pediatric Sarcoidosis

P Kg Gunathilaka¹, Aparna Mukherjee¹, Kana Ram Jat¹

¹Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Indian Pediatrics

|February 27, 2019

Insights

Pediatric sarcoidosis patients treated with steroids and methotrexate showed significant improvement. However, delayed diagnosis and eye involvement may lead to poorer outcomes in children with sarcoidosis.

Area of Science:

Pediatric Rheumatology
Pulmonology
Ophthalmology

Background:

Sarcoidosis is a multisystem inflammatory disease of unknown etiology.
Pediatric sarcoidosis is rare and presents with diverse clinical manifestations.
Understanding the clinical course and treatment response in children is crucial for effective management.

Purpose of the Study:

To document the clinical features of pediatric sarcoidosis.
To evaluate the treatment outcomes in children diagnosed with sarcoidosis.
To identify factors associated with a poor prognosis in pediatric sarcoidosis.

Main Methods:

Retrospective review of 18 children diagnosed with sarcoidosis between 2006 and 2016.
Regular monitoring of clinical, laboratory, and imaging parameters.
Assessment of treatment response and long-term outcomes.

Main Results:

Common symptoms included fever, uveitis, and respiratory difficulties.
Hilar adenopathy was the most frequent imaging finding (94%).
All patients responded well to systemic steroids and low-dose methotrexate, with significant symptom resolution and improved lung function.

Conclusions:

Systemic steroids and methotrexate are effective treatments for pediatric sarcoidosis.
Early diagnosis and prompt treatment are essential.
Ocular involvement and delayed diagnosis are associated with unfavorable outcomes.

Read full analysis

Abstract

Objective:

To document clinical features and outcome of children with sarcoidosis.

Methods:

Case records of 18 children (mean (SD) age 9 (2.2) years) diagnosed with sarcoidosis between 2006 and 2016 were reviewed. All children were followed up every 2-3 months and monitored for clinical and laboratory parameters. Their treatment and outcome were recorded.

Results:

Clinical features at the time of diagnosis were fever (83%), uveitis (50%), difficulty in breathing (44%), hepatosplenomegaly, weight loss, arthritis and peripheral adenopathy. Imaging findings included: hilar adenopathy (94%), abdominal nodes (50%) and pulmonary infiltrates (44%). All children were treated with steroids (range 6-12 months) and weekly low dose oral methotrexate. All patients showed significant improvement over a mean (SD) duration of follow-up of 3.1 (0.9) years, as assessed by resolution of clinical symptoms, and improvement in spirometry parameters, erythrocyte sedimentation rate, and serum angiotensin converting enzyme levels.

Conclusions:

Children with sarcoidosis seem to respond well to systemic steroids and low dose methotrexate. Delayed diagnosis and ocular involvement are probably associated with poor outcome.

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