Pulmonary symptoms are dominant, and more than 90 percent of patients have an abnormal chest radiograph at some point. Interstitial pneumonitis is the hallmark of pulmonary involvement, and half of afected patients develop permanent radiological changes. Lymphadenopathy, especially of the mediastinum, is present in 75 to 90 percent of cases. A fourth each have uveitis and skin involvement, the latter usually manifest as eythema nodosum. In women, sarcoid causes approximately 10 percent of cases of erythema nodosum (Mert, 2007). Impor tantly, any other organ system may be involved (Kandolin, 2015; Powe, 2015; Wallmiiller, 2012). Conirmation of the diagnosis is with biopsy-preferably a lymph node. However, because the lung may be the only obviously involved organ, tissue acquisition is often diicult.
The overall prognosis for sarcoidosis is good, and it resolves without treatment in 50 percent of patients. Still, quality of life is diminished (de Vries, 2007). In the other 50 percent, permanent organ dysfunction, albeit mild and nonprogressive, persists. Approximately 10 percent die because of their disease.
Glucocorticoids are the most widely used treatment for symptomatic disease. Permanent organ derangement is seldom reversed by their use (Paramothayan, 2002). Thus, the deci sion to treat is based on symptoms, physical indings, chest radiograph, and pulmonary function tests. Unless respiratory symptoms are prominent, therapy is usually withheld for a several-month observation period. If inlammation does not subside, then prednisone, 1 mg/kg, is given daily and tapered to < 10 mg by 6 months (Baughman, 2015). For those with an inadequate response, immunosuppressive or cytotoxic agents and cytokine modulators can be used.
Because it is uncommon and frequently benign, sarcoidosis is not often seen in pregnancy. Although it seldom afects pregnancy adversely, meningitis, heart failure, and neurosarcoidosis have been described (Cardonick, 2000; Maisel, 1996; Wallmiiller, 2012). In a study of the Nationwide Inpatient Sample of 678 cases of sarcoidosis in pregnancy, incidences of preeclampsia, preterm delivery, and thromboembolism were increased (Hadid, 2015). Selroos (1990) studied 252 women with sarcoidosis in Finland, and 15 percent had sarcoidosis during pregnancy. Disease did not progress in the 26 pregnancies in women with active disease. Three aborted spontaneously, and the other 23 women were delivered at term. Agha and coworkers (1982) reported similar experiences with 35 pregnancies at the University of Michigan.
Active sarcoidosis is treated using the same guidelines as for the woman who is not pregnant. Severe disease warrants serial determination of pulmonary function. Symptomatic uveitis, constitutional symptoms, and pulmonary symptoms are treated with prednisone, 1 mg/kg orally per day.