title: Management of extrapulmonary sarcoidosis: challenges and solutions.
abstract: BACKGROUND
  Sarcoidosis is a chronic multisystem disease of unknown etiology characterized by noncaseating granulomas that most often involves the lungs, but frequently has extrapulmonary manifestations, which might be difficult to treat in individual patients.
  
  
  OBJECTIVE
  To review different disease manifestations, focusing on extrapulmonary organ systems, and to provide treatment options for refractory cases.
  
  
  METHODS
  We performed a literature search using Medline and Google Scholar for individual or combined keywords of "sarcoidosis, extrapulmonary, treatment, kidney, neurosarcoidosis, cardiovascular, gastrointestinal, transplantation, musculoskeletal, rheumatology, arthritis, and skin". Peer-reviewed articles, including review articles, clinical trials, observational trials, and case reports that were published in English were included. References from retrieved articles were also manually searched for relevant articles.
  
  
  CONCLUSIONS
  Isolated involvement of a single organ or organ system is rare in sarcoidosis, and thus all patients must be thoroughly evaluated for additional disease manifestations. Cardiac sarcoidosis and neurosarcoidosis may be life-threatening. Clinicians need to assess patients comprehensively using clinical, laboratory, imaging, and histopathological data to recommend competently the best and least toxic treatment option for the individual patient.
authors.affiliation: Department of Molecular Biosciences, University of Kansas, Lawrence, KS, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Kofahi
authors.affiliation: Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Korsten
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
authors.forename: Christian
authors.initials: C
authors.lastname: Ascoli
authors.affiliation: Division of Rheumatology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Shanti
authors.initials: S
authors.lastname: Virupannavar
authors.affiliation: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mirsaeidi
authors.affiliation: Department of Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, MI.
authors.forename: Ian
authors.initials: I
authors.lastname: Chang
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, University of Buffalo, Buffalo, NY.
authors.forename: Naim
authors.initials: N
authors.lastname: Qaqish
authors.affiliation: New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Saketkoo
authors.affiliation: Department of Medicine, University Medical Center of Cincinnati, Cincinnati, OH, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Baughman
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL; Division of Rheumatology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Nadera J
authors.initials: NJ
authors.lastname: Sweiss
keywords: chronic granulomatous diseases; diagnostic tests; immunosuppressive agents; sarcoidosis