LIFE-THREATENING SITUATIONS IN SARCOIDOSIS

Life-threating situations in sarcoidosis are extremely rare. They may be due to failure of vital organs - lungs, heart, kidney, liver and br ain - and usually due to irreversible fibrosis. Respiratory failure fo llows irreversible pulmonary fibrosis and the development of cor pulmo nale. Cardiac sarcoidosis is more sinister for it may be silent, ill-r ecognised with sudden death or high morbidity. It needs sophisticated techniques to uncover this latent iceberg. Renal failure may be due to granulomatous interstitial nephritis and/or nephrocalcinosis. Hepatic failure is due to intrahepatic cholestasis, portal hypertension and b leeding oesophageal varices. Neurosarcoidosis carries a mortality of 1 0 per cent, over twice that of sarcoidosis overall. The treatment of e ach situation is discussed including organ transplantation.