GPAtlas🧭 When to suspect
Sarcoidosis is a multisystem granulomatous disease of unknown cause, defined histologically by non-caseating (non-necrotising) granulomas.
The lungs and intrathoracic lymph nodes are involved in over 90% of cases, but almost any organ can be affected – earning it the label of a great mimic.
Suspect it in a young to middle-aged adult (typically 20–40 years) presenting with:
• A persistent dry cough
• Exertional breathlessness
• Bilateral hilar lymphadenopathy on chest X-ray
Many patients are asymptomatic, the disease being found incidentally on a film requested for another reason.
Raise suspicion further with extra-pulmonary clues:
• Erythema nodosum (tender red shin nodules)
• Anterior uveitis
• Unexplained systemic symptoms such as fatigue, fever, weight loss or night sweats
It is more common, and often more severe, in people of Black African and African-Caribbean heritage (UK incidence roughly 5 per 100,000).
In general practice:
• Recognise the classic picture
• Screen for silent organ involvement (eyes, heart, calcium)
• Refer for confirmation – while remembering that a great many cases need observation only
| Scadding stage (chest X-ray) | Radiographic appearance | Note |
|---|---|---|
| Stage 0 | Normal chest X-ray | Extra-pulmonary disease only |
| Stage I | Bilateral hilar lymphadenopathy alone | High rate of spontaneous resolution |
| Stage II | Hilar lymphadenopathy and parenchymal infiltrates | Many still resolve |
| Stage III | Parenchymal infiltrates without hilar lymphadenopathy | Lower chance of resolution |
| Stage IV | Pulmonary fibrosis (end-stage) | • Irreversible • Higher morbidity |
Source: BTS Clinical Statement on pulmonary sarcoidosis
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