General symptoms

Sarcoidosis may cause general symptoms as listed opposite.

• Uneasiness, feeling sick (malaise), an overall feeling of ill health 
• Tiredness, fatigue, weakness
• Loss of appetite or weight
• Fever
• Night sweats
• Sleep problems

Lungs

Most affected organ, affects more than 90% of patients

(In about 50% of cases, the diagnosis is made on a routine Chest X- ray in a person who has no symptoms)

• Enlarged lymph nodes at the hila of the lung or around the trachea
• Infiltration of the lung tissue with normal lung function in early stages; breathlessness on effort, (small stiff lungs), and a restrictive lung disease picture in advanced disease)
• There are 4 “stages” of lung involvement - (see below)*

Skin

The second most commonly affected organ

Manifestations can be:

• In Europeans, erythema nodosum (raised, tender red lumps on the shins)
• Flat patches (plaques) in the skin in longstanding disease with raised waxy patches in skin and discoloration of the nose lips, ears and cheeks (Lupus Pernio); this occurs more in black females.
• Hyperpigmentation (excess pigment)
• Hypopigmentation (reduced pigment)
• Keloid reaction (thickened scarring of the skin following injury)

Eye manifestations

(Occur in around 15% to 25% of cases)

• Anterior and posterior uveitis (inflammation of the internal eye)
• Glaucoma due to the blockage to the drainage of intra- ocular fluid
• Dry eyes (Keratoconjunctivis Sicca) partly caused by sluggish lachrymal gland secretion
• Conjunctivitis
• Conjunctival granulomas
• Retinal lesions
• Optic nerve involvement

Anterior uveitis usually is short- lived, posterior uveitis is generally a more chronic condition. Blindness is rare.

Central Nervous System manifestations

Involvement is rare (2%), but the effects can be serious

• Cranial nerves may be affected
• Facial palsy (paralysis of the facial nerve) often bilateral is a well recognised complaint. This is known as Bell’s Palsy.
• Spinal cord disease
• Polyneuropathy
• Chronic meningoencephalitis
• Diabetes Insipidus (a condition of impaired water balance in the body)

Bone and Joint Involvement

(5%)

• Fever and joint pain (arthralgia) in Europeans, occurring more commonly in acute disease
• Bone cysts in the fingers (granulomas affect the bone and may lead to hypercalcaemia - high blood calcium)
• Hands and feet most commonly affected.

Liver and Spleen

(70% liver involvement, 50% liver and spleen involvement)

• Spleen can enlarge, occasionally the enlargement is massive, necessitating removal of the spleen.
• 70% have liver granulomas
• However disease causes symptoms in less than 10%

Heart Involvement

(3%)

Less common, more serious, and more difficult to identify

• Heart failure
• Cardiac arrythmias can be fatal
• Heart block
• Cardiomyopathy
• Sudden death

Metabolic

Hypercalcaemia is found in 10% of established cases. It can lead to the formation of renal stones and other kidney problems.