A 40 year old affrican american man presented with a 40 lb weight loss and a slight cough. His spirometry was normal. A CXR showed symmetrical bilateral hilar adenopathy and a transbronchial biopsy of the upper lung showed noncaseating granulomas, consistent with sarcoid. He has no complaints of shortness of breath.
Would you treat with steroids? Is there any caveats or different management decisions regarding sarcoid, when the only presenting abnormality is weight loss (SOB absent with normal PFTs).
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Tough call.
Can we safely assume that you have no other reason to treat (Cardiac disease, hypercalcemia, ocular disease, etc)?
Can we also assume that this individual has had an age appropriate malignancy screening?
If yes to both, I suppose a short course of steroids would be reasonable. The patient probably has excess cytokines that cause weight loss and they may me "turned off" with prednisone for a few weeks.
This has certainly been described before:
Drent M et al. Eur Respir J. 1999 Apr;13(4):718-22.Click here to read
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