575 CHILDHOOD SARCOIDOSIS

A wide range of clinical and laboratory manifestations have been reported in childhood sarcoidosis. We are presenting the findings from a review of the largest series reported to date. Sixty patients were diagnosed with sarcoidosis by biopsy (47) or chest x-ray (CXR) and clinical course (13). Fifty-four percent were male, 72% black, 88% lived on the coastal plain of N.C., 75% presented in the winter or spring, and the average age was 13.3 yrs. Common symptoms were weight loss (54%), cough (53%), and fatigue (48%). Common physical findings included peripheral lymphadenopathy (58%), eye changes (54%), and skin changes (42%). All but 1 had an abnormal CXR. Frequently abnormal laboratory tests included an elevated ESR (74%), eosinophilia (45%), increased gamma-globulins (88%), hypercalcemia (31%), hypercalciuria (67%), and pulmonary function tests (50% with restrictive changes). Distinctive features not emphasized fully in the past were the prominence of eye involvement, hypercalcemia/hypercalciuria, skin involvement and the multisystem involvement. After an average of 4.7 yrs, of follow-up, there was considerable improvement in clinical manifestations, CXR findings, and pulmonary function; however, there was 1 death, 35% had continued physical abnormalities, and 47% had CXR findings. Because children treated with adrenocorticosteroids had more severe disease, evaluation of therapy could not be done. Due to the larger number of children in this series, the clinical manifestations are clarified and knowledge of the distinctive features should improve the management of childhood sarcoidosis.