The etiology of sarcoidosis is unknown, but it is known that it is a disease of disordered immune regulation.
There are several immunological abnormalities which suggest the development of a cell-mediated response to an unidentified antigen, driven by CD4+ helper T cells. Thus, sarcoidosis is an immune-mediated disorder.
This disease leads to noncaseating (hard) granulomas in many tissues and organs. These are typically composed of clustered aggregated epithelioid cells, often with Langhans or foreign body-type giant cells.
Within macrophages, 1α-hydroxylase-mediated Vitamin D activation occurs. Thus, patients often show lab values correlating with increased Vitamin D.
Due to vitamin D activation, calcium absorption is increased in the gut and patients show serum hypercalcemia.
Sarcoidal granulomas produce ACE, and patients with this disease display elevated serum ACE levels.
Asteroid bodies, which are formed from lipids arranged in bilayer membranes, are microscopic findings found in the granulomas of sarcoidosis.
Often an incidental finding, patient chest x-rays show bilateral hilar adenopathy, and sometimes reticular opacities.
Corticosteroids have been the standard of treatment for many years and have been shown to slow or reverse the course of this disease.
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