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Acute Complications of Sarcoidosis

Practice Essentials

Emergency medicine physicians may diagnose sarcoidosis de novo or provide emergent management of its exacerbations, recurrences, and/or acute complications. Sarcoidosis is a chronic noncaseating granulomatous disease of unknown etiology that affects many organs and tissues, most commonly the lungs. Although sarcoidosis may be suspected because of a patient’s history, it usually is diagnosed by using chest radiography and histology. (See the images below.)

Stage II sarcoidosis. Courtesy of Anthony Notino,

Stage II sarcoidosis. Courtesy of Anthony Notino, MD, New York Hospital, Department of Radiology, Cornell Medical Center.

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Stage II sarcoidosis. Courtesy of Anthony Notino,

Stage II sarcoidosis. Courtesy of Anthony Notino, MD, New York Hospital, Department of Radiology, Cornell Medical Center.

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Stage II sarcoidosis. Courtesy of Anthony Notino,

Stage II sarcoidosis. Courtesy of Anthony Notino, MD, New York Hospital, Department of Radiology, Cornell Medical Center.

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Stage II sarcoidosis. Courtesy of Anthony Notino,

Stage II sarcoidosis. Courtesy of Anthony Notino, MD, New York Hospital, Department of Radiology, Cornell Medical Center.

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Stage II sarcoidosis. Courtesy of Anthony Notino,

Stage II sarcoidosis. Courtesy of Anthony Notino, MD, New York Hospital, Department of Radiology, Cornell Medical Center.

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The treatment of symptomatic sarcoidosis usually includes glucocorticoids, and cytotoxic drugs such as methotrexate, azathioprine, cyclosphosphamide, mycophenolate mofetil. Biologic therapy with a tumor necrosis factor alpha (TNFα) antagonist (eg, adalimumab) may be considered in severe or refractory sarcoidosis. The use of immunosupressive drugs, mainly cyclosphosphamide, is associated with an increased risk for infection
 

Patients with sarcoidosis also have a higher risk of cardiovascular disease (CVD) and glucocorticoids, the most commonly used medication in management of sarcoidosis, may be a contributing factor as long-term use is associated with several traditional CVD risk factors such as diabetes mellitus, hypertension, and dyslipidemia.
 

In a population-based retrospective study, a threefold increased risk of venous thromboembolism (VTE) was reported with significantly elevated risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE).

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