Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What are some signs and symptoms that suggest possible sarcoidosis?
In addition to the lungs and lymph nodes, the body organs
more likely than others to be affected by sarcoidosis are the liver, skin,
heart, nervous system, and kidneys, in that order of frequency. Patients can
have symptoms related to the specific organ affected, they can have only general
symptoms, or they can be without any symptoms whatsoever. Symptoms also can vary
according to how long the illness has been under way, where the granulomas are
forming, how much tissue has become affected, and whether the granulomatous
process is still active.
Even when there are no symptoms, a doctor can sometimes
detect signs of sarcoidosis during a routine examination, usually a chest x-
ray, or when checking out another complaint. The patient's age and race or
ethnic group can raise an additional red flag that a sign or symptom of illness
could be related to sarcoidosis. Enlargement of the salivary or tear glands and
cysts in bone tissue are also among sarcoidosis signals.
The lungs are usually the first site involved in
sarcoidosis. Indeed, about nine out of 10 sarcoidosis patients have some type of
lung problem, with nearly one-third of these patients showing some respiratory
symptoms—usually coughing, either dry or with phlegm, and
dyspnea. Occasionally, patients have chest pain and a feeling of tightness in the chest.
It is thought that sarcoidosis of the lungs begins with
inflammation of the alveoli (alveolitis), the tiny sac-like air spaces in the lungs where carbon dioxide and
oxygen are exchanged. Alveolitis either clears up spontaneously or leads to
granuloma formation. Eventually fibrosis can form, causing the lung to stiffen
and making breathing even more difficult.
Eye disease occurs in about 20%-30% of patients
with sarcoidosis, particularly in children who get the disease. Almost any part
of the eye can be affected—the membranes of the eyelids, cornea, outer coat of
the eyeball (sclera), retina, and lens. The eye
involvement can start with no symptoms at all or with reddening or watery eyes.
In a few cases, cataracts, glaucoma, and blindness can result.
The skin is affected in about 20% of sarcoidosis
patients. Skin sarcoidosis is usually marked by small, raised patches on the
face. Occasionally, the patches are purplish in color and larger.
Patches can also appear on limbs, face, and buttocks.
Other symptoms include erythema nodosum, mostly on the legs and often accompanied by arthritis in the ankles, elbows, wrists, and hands. Erythema nodosum usually goes away, but other skin problems can
persist.
Occasionally (1%-5%), sarcoidosis can lead to
nervous system problems. For example, sarcoid granulomas can appear in the
brain, spinal cord, and facial and optic nerves. Facial
paralysis and other symptoms of nerve damage call for prompt treatment with medications such as high doses of cortisone (see below). Also, people with sarcoidosis can have depression that is unrelated to the activity of the disease and is felt to be, in part, because of a misdirected immune system.
Symptoms can appear suddenly and then disappear. Sometimes,
however, they can continue over a lifetime.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Carpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. This condition is known as tarsal tunnel syndrome in the ankles and feet. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Eye floaters are deposits or condensation that forms in the eye's vitreous humor. These deposits cast shadows on the retina, and as the eye moves, the deposits shift position, making it appear as though the shadows are moving or floating.
Pulmonary hypertension is an abnormal elevation of the pressure in the pulmonary circulation caused by the constriction of the blood vessels that supply blood to the lungs. Shortness of breath and dizziness are symptoms of pulmonary hypertension. Treatment involves diuretics, blood thinners, calcium channel blockers, and using supplemental oxygen to increase blood oxygen levels.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. Erythema nodosum can resolve on its own in 3 to 6 weeks, leaving a bruised area. Treatments include anti-inflammatory medications and cortisone by mouth or injection.
Pericarditis is the inflammation of the pericardial sac that surrounds the heart. The causes of pericarditis include injury from heart attack, heart surgery, trauma; viral or fungal infection, HIV, tumors, mixed connective tissue disease, metabolic disease, medication reactions, or idiopathic. Treatment for pericarditis is generally medication, however, sometimes surgery is necessary.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Myocarditis is an inflammation of the heart muscle and can be caused by a variety of infections, conditions, and viruses. Symptoms of myocarditis include chest pain, shortness of breath, fatigue, and fluid accumulation in the lungs. Treatment mainly involves preventing heart failure with medication and diet, as well as monitoring for heart rhythm abnormalities.
Sudden cardiac arrest is an unexpected, sudden death caused by sudden cardiac arrest (loss of heart function). Causes and risk factors of sudden cardiac arrest include (not inclusive): abnormal heart rhythms (arrhythmias), previous heart attack, coronary artery disease, smoking, high cholesterol, Wolff-Parkinson-White Syndrome, ventricular tachycardia or ventricular fibrillation after a heart attack, congenital heart defects, history of fainting, and heart failure, obesity, diabetes, and drug abuse. Treatment of sudden cardiac arrest is an emergency, and action must be taken immediately.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Iritis is inflammation of the iris, the colored portion of the eye. Symptoms include a red, painful eye, blurry vision, and light sensitivity. Treatment usually involves cortisone eyedrops.
Superior vena cava syndrome is compression of the superior vena cava vein located in the upper chest. Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or infection. Symptoms of the syndrome include shortness of breath. Superior vena cava syndrome is diagnosed by ultrasound, chest x-ray, CT scan, and in some cases biopsy. Treatment depends upon the cause of the syndrome.
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