eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Sarcoidosis: Follow-up

Author: Avinash Shetty, MD, Department of Pediatrics, Division of Pediatric Infectious Diseases, Assistant Professor of Pediatrics, Wake Forest University School of Medicine
Coauthor(s): Abraham Gedalia, MD, Head, Division of Pediatric Rheumatology, Professor of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans
Contributor Information and Disclosures

Updated: Jul 7, 2009

Follow-up

Complications

  • Because sarcoidosis can involve any organ in the body, potential complications can include a gamut of abnormalities.
  • Progressive interstitial lung disease with restrictive ventilatory pattern can occur.
  • Untreated ocular disease may result in synechiae, glaucoma, and blindness.
  • Other unusual but serious complications described in childhood sarcoidosis include nephrolithiasis, nephrocalcinosis, cranial nerve palsies, and cardiac disease, including vasculitis involving the aortic arch.

Prognosis

  • The prognosis and natural history of sarcoidosis in children is unclear because of the rarity of the disease and the small number of reported cases. However, the overall prognosis of childhood sarcoidosis is reported as good compared with the prognosis for adults, with most children experiencing considerable improvement in clinical manifestations, chest radiograph findings, and pulmonary function test results. In the University of North Carolina series, most patients had considerable improvement in the clinical manifestations, chest radiograph findings, and pulmonary function test results; however, 40% were still symptomatic and 35% had physical abnormalities after an average follow-up of 5 years.3
  • Although most children apparently improve, a significant number of patients have sequelae or experience major complications; however, the mortality rate is low. A review of 5 large series of childhood cases of sarcoidosis showed that 6 of 176 patients died, for an overall mortality rate of 3%. Asymptomatic cases usually have a favorable outcome, with spontaneous regression in many patients. Symptomatic patients with multisystemic involvement often experience chronic disease, with residua in about 20%, mainly involving the eyes and lungs.
  • Early onset sarcoidosis with involvement of the eyes, joints, and skin suggests a guarded prognosis with the likelihood of a chronic progressive course and even life-threatening complications; 80-100% of these children develop residua of uveitis, polyarthritis, and other organ involvement. Progressive ocular disease may produce severe disability, with secondary glaucoma resulting in blindness. Periodic ophthalmologic evaluations are essential in all cases of childhood sarcoidosis to identify ocular disease and prevent further morbidity.
  • Currently, serial clinical examinations focusing on the severity of the disease in affected organs remain the best approach to prognosis.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose sarcoidosis can cause increased morbidity and mortality, leading to potential medicolegal problems and litigation.
 


More on Sarcoidosis

Overview: Sarcoidosis
Differential Diagnoses & Workup: Sarcoidosis
Treatment & Medication: Sarcoidosis
Follow-up: Sarcoidosis
Multimedia: Sarcoidosis
References
Further Reading
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Keywords

sarcoidosis, Besnier-Boeck-Schaumann disease, Besnier-Boeck-Schaumann syndrome, Boeck disease, Boeck's disease, Boeck sarcoid, Boeck's sarcoid, sarcoid, Schaumann syndrome, Schaumann's syndrome, sarcoid granulomas, tuberculosis, uveitis, polyarthritis, blindness, growth retardation, renal failure, glaucoma, pleural effusion, pneumothorax, pleural thickening, calcification, atelectasis, cor pulmonale, juvenile rheumatoid arthritis, scar sarcoidosis, erythema nodosum, Lofgren syndrome, nephrolithiasis, nephrocalcinosis, cardiac sarcoidosis, neurosarcoidosis, meningitis, seizures, hypopituitarism, diabetes insipidus, cerebellar ataxia, Heerfordt syndrome, pericarditis, myocarditis, intraventricular thrombosis, Mycobacterium tuberculosis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Avinash Shetty, MD, Department of Pediatrics, Division of Pediatric Infectious Diseases, Assistant Professor of Pediatrics, Wake Forest University School of Medicine
Avinash Shetty, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Coauthor(s)

Abraham Gedalia, MD, Head, Division of Pediatric Rheumatology, Professor of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans
Abraham Gedalia, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Rheumatology
Disclosure: Nothing to disclose.

Medical Editor

Susanna A McColley, MD, Director of Cystic Fibrosis Center; Head, Division of Pulmonary Medicine; Associate Professor, Department of Pediatrics, Children's Memorial Medical Center of Chicago, Northwestern University
Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, and American Thoracic Society
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Honoraria Consulting; Novartis Honoraria Consulting; Altus  Consulting fee Consulting; Axcan Scandi Consulting fee Consulting; Boston Scientific Consulting fee Consulting; Gilead  Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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