The Most Difficult Disease to Diagnose Even With Biopsy

Sarcoidosis is granulomatous autoinflammatory autoimmune remitting relapsing disease affecting every organ in the body, it is the most difficult disease to diagnose in the absence of serum or imaging biomarker, Differential diagnosis is broad which included inflammatory, infective, neurodegenerative and neoplastic, histological biopsy is the only confirmative marker, and even histological confirmation is not robust as infection, malignancy and some drugs can induce granuloma, the most common organs affected are lung, lymph nodes, skin, eyes, liver, and less commonly pituitary gland, bones, brain, peripheral nerves, and heart, causing bilateral hilar lymphadenopathy, granulomatous lymphadenitis.Lupus pernio and erythema nodosum, optic neuritis, granulomatous hepatitis, diabetes insipidus, periosteal bone erosion, pacchy and leptomeningitis, cardiomyopathy and conduction arrythmia respectively, two well scribed syndromes, the first one hereford syndrome which encompass granulomatous uveitis, parotid and submandibular lymphadenitis, and 7th nerve neuropathy, other cranial nerve might be involved, second syndrome is lofgren syndrome which comprise fever, arthritis, erythema nodsum, and hilar lymphadenopathy, prevalence of the disease is highest in western countries than asian and middle east population, it affects females more than males, the age of onset above 45 years up to 60, women can be affected at an elder age, sarcoidosis can be presented as subacute monofocal affecting one system or multifocal.Affecting few systems at the same time, mortality rate is greater than in general population if it affected the heart or brain, sarcoidosis can be remitting relapsing where patient will be fully asymptomatic after the relapse, or could be primary progressive where patient will never inter into complete remission after the first relapse or it could be secondary progressive where patients continue to have residual illness after each relapse.