Approach Considerations
The goal of therapy in sarcoidosis is to prevent or minimize inflammation and granuloma formation (ie, disease activity) leading to organ system dysfunction, which may ultimately cause end-stage organ destruction by the development of hyaline fibrosis. Treatment is symptomatic and supportive.
Glucocorticoids remain the therapy of choice for children with multisystem involvement. However, because the disease clears spontaneously in approximately 50% of patients and because permanent organ dysfunction often does not improve with glucocorticoids, no clear consensus has been established among clinicians as to the criteria for treatment.
Some reports suggest that methotrexate (MTX) administered orally in low doses in childhood sarcoidosis is effective, safe, and exhibits steroid-sparing properties. Data regarding efficacy of other immunosuppressive agents, such as azathioprine, cyclophosphamide, chlorambucil, and cyclosporine in adult sarcoidosis, have been limited to anecdotal, uncontrolled reports.
Consultations
Pulmonologist
Determining the extent and activity of the inflammatory process in the organs at greatest risk, such as the lung, is critical to make decisions regarding therapy in sarcoidosis. A complete medical history and physical examination in conjunction with chest radiography and pulmonary function tests are helpful in evaluating the pulmonary disease.
Ophthalmologist
Referral to a pediatric ophthalmologist is invaluable in suspected cases of childhood sarcoidosis, because eye lesions frequently occur. Decisions concerning therapy are based on slitlamp examination and tests for visual acuity.
Rheumatologist
All suspected cases of childhood sarcoidosis necessitate prompt referral to a pediatric rheumatologist for the initial diagnostic evaluation and subsequent management, including long-term follow-up.
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Chest radiograph showing bilateral hilar lymphadenopathy in a 10-year-old girl with sarcoidosis.
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Chest radiograph showing patchy diffuse pulmonary infiltrates involving both lung fields in a 12-year-old girl at onset of her sarcoidosis (left). A repeated study 6 months later showing almost complete resolution of the infiltrates (right).
