What Are the Signs and Symptoms of Sarcoidosis?

Many people who have sarcoidosis have no symptoms. Often, the condition is discovered by accident only because a person has a chest x ray for another reason, such as a pre-employment x ray.

Some people have very few symptoms, but others have many.

Symptoms usually depend on which organs the disease affects.

Lung Symptoms

• Shortness of breath
• A dry cough that doesn't bring up phlegm (flem), or mucus
• Wheezing
• Pain in the middle of your chest that gets worse when you breathe deeply or cough (rare).

Lymph Node Symptoms

• Enlarged and sometimes tender lymph nodes—most often those in your neck and chest but sometimes those under your chin, in your arm pits, or in your groin.

Skin Symptoms

• Various types of bumps, ulcers, or, rarely, flat areas of discolored skin, that appear mostly near your nose, eyes, back, arms, legs, and scalp. They usually itch but aren't painful. They usually last a long time.
• Painful bumps that usually appear on your ankles and shins and can be warm, tender, red or purple-to-red in color, and slightly raised. This is called erythema nodosum (er"i-the'mah nodo'sum). You may have fever and swollen ankles and joint pain along with the bumps. The bumps often are an early sign of sarcoidosis, but they occur in other diseases too. The bumps usually go away in weeks to months, even without treatment.
• Disfiguring skin sores that may affect your nose, nasal passages, cheeks, ears, eyelids, and fingers. This is called lupus pernio (loo'pus per'nio). The sores tend to be ongoing and can return after treatment is over.

Eye Symptoms

• Burning, itching, tearing, pain
• Red eye
• Sensitivity to light
• Dryness
• Floaters (i.e., seeing black spots)
• Blurred vision
• Reduced color vision
• Reduced visual clearness
• Blindness (in rare cases).

Heart Symptoms

• Shortness of breath
• Swelling in your legs
• Wheezing
• Coughing
• Irregular heartbeat, including palpitations (a fluttering feeling of rapid heartbeats) and skipped beats
• Sudden loss of consciousness
• Sudden death.

Joint and Muscle Symptoms

• Joint stiffness or swelling—usually in your ankles, feet, and hands.
• Joint pain.
• Muscle aches (myalgias).
• Muscle pain, a mass in a muscle, or muscle weakness.
• Painful arthritis in your ankles that results from erythema nodosum. It may need treatment but usually clears up in several weeks.
• Painless arthritis that can last for months or even years. It should be treated.

Bone Symptoms

• Painless holes in your bones.
• Painless swelling, most often in your fingers.
• Anemia that results from granulomas affecting your bone marrow. This usually should be treated.

Liver Symptoms

• Fever
• Fatigue
• Itching
• Pain in the upper right part of your abdomen, under the right ribs
• Enlarged liver.

Parotid (pah-rot'id) and Other Salivary Gland Symptoms

• Swelling, which makes your cheeks look puffy
• Excessive dryness in your mouth and throat.

Blood, Urinary Tract, and Kidney Symptoms

• Increased calcium in your blood or urine, which can lead to painful kidney stones
• Confusion
• Increased urination.

Nervous System Symptoms

• Headaches.
• Vision problems.
• Weakness or numbness of an arm or leg.
• Coma (rare).
• Drooping of one side of your face that results from sarcoidosis affecting a facial nerve. This can be confused with Bell's palsy, a disorder that may be caused by a virus.
• Paralysis of your arms or legs that results from sarcoidosis affecting your spinal cord.
• Weakness, pain, or a "stinging needles" sensation in areas where many nerves are affected by sarcoidosis.

Pituitary (pi-tu'i-tar"e) Gland Symptoms (Rare)

• Headaches
• Vision problems
• Weakness or numbness of an arm or leg
• Coma (rare).

Other Symptoms

• Nasal obstruction or frequent bouts of sinusitis.
• Enlarged spleen, which leads to a decrease in platelets in your blood and pain in your upper left abdomen. Platelets are needed to help your blood clot.

Sarcoidosis may also cause more general symptoms, including:

• Uneasiness, feeling sick (malaise), an overall feeling of ill health
• Tiredness, fatigue, weakness
• Loss of appetite or weight
• Fever
• Night sweats
• Sleep problems

These general symptoms are often caused by other conditions. If you have these general symptoms but don't have symptoms from affected organs, you probably do not have sarcoidosis.

Sarcoidosis

This graph shows the average number of cases of sarcoidosis that occurred in specific organs in participants in a large clinical study in the United States in the late 1990s. It shows, for example, that among every 100 of these patients, 95 had sarcoidosis in their lungs.

ACCESS Study, Am J Respir Crit Care Med, Vol. 164, p. 1885, 2001