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, and 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, or 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). The key primary-care skills are to recognise the classic picture, screen for silent organ involvement (eyes, heart, calcium), and 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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