Pulmonary Involvement in Childhood Sarcoidosis

Sarcoidosis is a rare, long-term inflammatory disease defined by granulomatous inflammation, primarily affecting the lungs, eyes, skin, lymph nodes, and liver. The disease is uncommon in children; it is more frequently seen in adolescents, with an estimated incidence of 0.6–1.02 per 100,000. The pathophysiology of pediatric sarcoidosis is believed to be influenced by a multifactorial etiology involving both genetic and environmental components, such as exposure to organic or mineral triggers. Common symptoms include constitutional signs such as fever, weight loss, and fatigue, in addition to multi-organ involvement, with the lungs, liver, and eyes being the most frequently affected organs. Diagnosis is primarily established through clinical evaluation, supported by the presence of noncaseating granulomas on histopathologic examination, after ruling out other potential causes of granulomatous inflammation. Treatment typically involves corticosteroids, which can be administered orally or intravenously over extended periods. In cases of corticosteroid resistance or relapse, immunosuppressive agents may be considered. The prognosis is generally favorable for most children, but some may continue to experience persistent pulmonary abnormalities and alveolitis even after treatment. Given the unpredictable progression of the disease and frequent relapses, long-term follow-up care is essential. A smooth transition of medical management to adult care providers is also crucial to ensure continuity of care. This review aims to enhance understanding, diagnosis, and management of pediatric sarcoidosis and its associated pulmonary involvement, underscoring the need for further research in this relatively underexplored area.