Sarcoidosis: An Exercise in Differential Diagnosis

¹ Assistant Professor of Medicine, Temple University Health Sciences Center
² Professor of Medicine, Temple University Health Sciences Center

We have presented in some detail eight cases from a series of 70 patients with biopsy-confirmed sarcoidosis. These individuals are interesting either because of uncommon presenting symptoms or unusual developments during the course of the disease. Thus, two patients were first seen because of massive splenomegaly; one (R. S.) had portal hypertension and hypersplenism, while another (G. S.) had such abdominal enlargement that she thought she was pregnant, but did not have significant hypersplenism. One (R. T.) had exploratory surgery for parathyroid adenoma; another (C. E.) had biopsy of a suspected enchondroma before diagnosis of sarcoidosis could be made.

Among the patients with uncommon features during the course of established sarcoidosis were two with repeated major hemoptyses. One of these (F. W.) bled to death; she, incidentally, first presented with ecthyma. The other patient with severe hemoptysis (T. Y.) also had repeated spontaneous pneumothoraces. Pericardial effusion with tamponade occurred in one patient (A. S.). One individual (J. H.) had phrenic nerve paralysis.

From our experience it might well be said that sarcoidosis has usurped the place of syphilis and is now the "great imitator" which must be considered in the differential diagnosis of many obscure syndromes in all fields of medicine.