An inflammatory disease characterized by the presence
of granulomas (small areas of inflamed cells) that usually affects the
lungs. Pulmonary sarcoidosis usually leads to restrictive pulmonary disease
with significant loss of lung tissue. However, all organs can be affected
and the nodule can be seen as sores if the skin is involved.
Boeck Sarcoid; Besnier-Boeck-Schaumann Disease; Schaumann
May have a nongenetic basis but presents a familial
predisposition. Seems to be more likely to present with class I HLA A1, B8,
Worldwide, affecting persons of all races, both sexes,
and all ages. Interestingly, cases present most commonly in the winter and
early spring months. About 1 to 40 cases per 1,000,000 population. More
frequent in blacks than in whites.
Systemic disorder of unknown cause characterized by
noncaseating granulomas. Most typically, sarcoidosis is an interstitial lung
disorder involving alveoli, blood vessels, and bronchioles, and producing
clinical findings of dry rales, restricted lung volumes, and abnormalities
in gas exchange.
Bilateral hilar adenopathy, pulmonary
infiltration. Erythema nodosum, maculopapular rash, enlarged lacrimal
glands, iridocyclitis, glaucoma, and chorioretinitis. Enlarged salivary
glands. Bone cysts. Associated with inflammatory bowel disease, especially
Crohn disease. Hyperglobulinemia, multisystem granulomatous disease with
positive Kveim test. Neurosarcoidosis can mimic more common disease
processes, such as meningioma, glioma, or metastases. The granulomas are
frequently present in multiple organs, including the liver. Serious cardiac
dysfunction is detected in 5 to 10% of patients. Sudden deaths are
described. The main clinical feature with cardiac sarcoidosis is the recording of ECG abnormalities in
terms of rhythm, conduction, and repolarization. Some have papillary muscle
dysfunction, infiltrative cardiomyopathy with congestive heart failure, and
It is highly recommended to obtain an
anesthesiology consultation before any elective surgical procedures. Because all organs
can be involved, perform a complete cell blood count, electrolytes (sodium, potassium and
calcium), creatinine, liver function tests, ECG, and chest radiography. In an acute
case, echocardiography can be helpful. The serial pulmonary function tests and chest
radiography are the best predictive values in long term.
Coincidentally or not, the complete
heart block cases reported during anesthesia are described with enflurane
anesthesia. Airway complications caused by laryngeal involvement and
bronchial stenosis have also been described.
Because these patients are chronically on steroid therapy, they will need to receive
steroid supplementation during the perioperative stress period. Sometimes the
musculoskeletal involvement responds better to methotrexate. Avoid succinylcholine and
other drugs that may increase intraocular pressure in the presence of glaucoma.
Newman LS, Rose CS, Maier LA: Sarcoidosis. N Engl J Med
Thomnas DW, Mason RA: Complete heart block during anesthesia in a patient
with sarcoidosis. Anesthesia 43(7):578, 1988.