Synopsis
Recognise pulmonary and multisystem sarcoidosis, secure proportionate diagnostic evidence and treat only when organ threat, disability or unacceptable quality-of-life loss justifies risk.
- Sarcoidosis is a multisystem granulomatous disorder of uncertain cause; pulmonary involvement is common but symptoms and organ risk vary widely.
- Bilateral hilar and mediastinal lymphadenopathy, perilymphatic nodules and upper-zone fibrosis are characteristic imaging patterns, not independently diagnostic findings.
- Many patients with typical, non-threatening disease improve spontaneously and do not need systemic treatment.
Key red flags
Unexplained syncope or presyncope, persistent palpitations, conduction block, ventricular arrhythmia or new heart failure may indicate cardiac sarcoidosis and requires urgent specialist evaluation.
Investigation priorities
Define thoracic distribution and select a safe diagnostic site.
Management branches
Imaging and clinical findings suggest pulmonary sarcoidosis.
- Assess severity and ask deliberately about cardiac, eye and neurological red flags, exposures, travel, immune status, constitutional symptoms and medicines.
- Review chest imaging with thoracic radiology, obtain physiology and baseline blood tests, then decide whether the presentation is sufficiently typical for observation without biopsy.
Key medicines
PrednisoloneFor clinically significant pulmonary disease, BTS describes an initial specialist regimen commonly around 20–40 mg orally daily for several weeks, followed by response-guided tapering toward 5–10 mg daily; individual schedules and duration vary.
MethotrexateA sarcoidosis specialist prescribes a once-weekly oral or subcutaneous dose, usually titrated from a low starting regimen according to local protocol, with folic acid given on separate days.