Obstructive Disease of the Airways Associated With Stage I Sarcoidosis

Stage I sarcoidosis usually presents with roentgenographic evidence of hilar adenopathy and the patients are totally asymptomatic. However, five patients were studied at the Mayo Clinic who had stage I sarcoidosis associated with obstructive disease of the airways. Four of the five presented with dyspnea, wheezing, and cough, and they were found to have expiratory slowing on physical examination. One patient was asymptomatic and her physical examination was normal. On pulmonary function testing, she had a decrease in maximal midexpiratory flow, and at fiberoptic bronchoscopy, mucosal changes consistent with noncaseating granuloma of sarcoidosis were seen. All five patients had the classic roentgenographic appearance of sarcoidosis, with hilar and right paratracheal adenopathy. Endobronchial involvement is well known in sarcoidosis, but its significance in stage I disease has not been emphasized in the literature. An awareness of this possibility is important because it may be an indication for bronchoscopy and mucosal biopsy in the patient with stage I sarcoidosis, particularly when the patient presents with dyspnea, wheezing, and cough. Also, corticosteroid, therapy may be indicated in selected patients with stage I sarcoidosis.