Delays in diagnosis in patients with pulmonary and extrapulmonary sarcoidosis
Delays in diagnosis in patients with pulmonary and extrapulmonary sarcoidosis
Aim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently withoutsymptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progressionleads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonaryand/or extra-pulmonary involvement and related symptoms and those without symptoms.Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases weregrouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared withregard to the delay in diagnosis.Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage IIin 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic andasymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observedbetween patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-relateddiagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to belonger in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, nodifference was observed between groups with regard to the duration until diagnosis(p=0.78).Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptomsrevealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is veryimportant in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increasethe possibility of diagnosis and prevent delayed diagnosis.
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- 1. Jamilloux Y, Bonnefoy M, Valeyre D, et al. Elderly-onset
sarcoidosis: prevalence, clinical course, and treatment.
Drugs Aging 2013;30:969-78.
- 2. Al-Mayouf SM, Al-Sonbul A, Al Jumaah S, et al. Sarcoidosis:
a delayed or missed diagnosis in children. Ann Saudi Med
2006;26:220-3.
- 3. Iannuzzi MC, Fontana JR. Sarcoidosis: clinical presentation,
immunopathogenesis, and therapeutics. JAMA
2011;305:391-9.
- 4. Dempsey OJ, Paterson EW, Kerr KM, et al. Sarcoidosis. BMJ
200928;339:b3206.
- 5. Rodrigues MM, Coletta EN, Ferreira RG, et al. Delayed
diagnosis of sarcoidosis is common in Brazil. J Bras
Pneumol. 2013;39:539-46.
- 6. Gerke AK, Judson MA, Cozier YC, et al. Disease Burden and
Variability in Sarcoidosis. Ann Am Thorac Soc 2017;14:421-
8.
- 7. Gerke AK, Tang F, Pendergast J, et al. The high frequency of
healthcare use in patients one year prior to a sarcoidosis
diagnosis. Sarcoidosis Vasc Diffuse Lung Dis 2014;31:256-61.
- 8. Judson MA, Thompson BW, Rabin DL, et al. The diagnostic
pathway to sarcoidosis. Chest 2003;123:406-12.
- 9. Statement on sarcoidosis. Joint Statement of the American
Thoracic Society (ATS), the European Respiratory Society
(ERS) and the World Association of Sarcoidosis and Other
Granulomatous Disorders (WASOG) adopted by the ATS
Board of Directors and by the ERS Executive Committee,
February 1999. Am J Respir Crit Care Med 1999;160:736-55.
- 10. Güneylioglu D, Yilmaz A, Bilgin S, et al. Factors affecting
delays in diagnosis and treatment of pulmonary tuberculosis
in a tertiary care hospital in Istanbul, Turkey. Med Sci Monit
2004;10:CR62-7.
- 11. Okur E, Yilmaz A, Saygi A, et al. Patterns of delays in
diagnosis amongst patients with smear-positive pulmonary
tuberculosis at a teaching hospital in Turkey. Clin Microbiol
Infect 2006;12:90-2.
- 12. Wirnsberger RM, de Vries J, Wouters EF, et al. Clinical
presentation of sarcoidosis in the netherlands an
epidemiological study. Neth J Med 1998;53:53-60.
- 13. Morimoto T, Azuma A, Abe S, et al. Epidemiology of
sarcoidosis in Japan. Eur Respir J 2008;31:372-9.
- 14. Silva LC, Hertz FT, Cruz DB, et al. Sarcoidosis in the south of
Brazil: a study of 92 patients. J Bras Pneumol 2005;31:398-
406.