diagnostic workup and management, and for respiratory monitoring and support Any pediatric patient who requires fluid drainage in the ED should be admitted SARCOIDOSIS CLINICAL PEARLS AND PITFALLS Sarcoidosis is a rare condition with development of noncaseating granulomas, abnormal adenopathy, and possibly multisystem involvement Corticosteroids are the most common medication used to treat sarcoidosis, indicated if significant lung, eye, cardiac, or central nervous system involvement, or multisystem involvement Current Evidence Sarcoidosis is a rare, chronic, granulomatous disease of unknown cause Lungs are the most affected organs although joints, skin, eyes, lymph nodes, liver, spleen, muscle, and brain can all be involved Involved organs have accumulations of T lymphocytes and mononuclear phagocytes, noncaseating epithelioid granulomas, and derangements of normal tissue architecture Although the exact cause is unknown, evidence suggests a multifactorial etiology; both environmental and genetic factors result in an exaggerated cellular immune response to an unclear antigen Goals of Treatment Goals of treatment include identifying the extent of involvement of the disease, and providing supportive care and using corticosteroids as indicated Clinical Considerations Clinical Recognition The incidence of sarcoidosis varies with age, race, and geography Most patients are adults between the ages of 20 and 40 years Most pediatric cases present in the second decade, although cases of patients less than year of age have been reported The disease is often acute or subacute and also self-limiting However, for some, it is chronic, with waxing and waning symptoms over many years The most common initial symptoms are nonspecific and may include malaise, fatigue, fever, and weight loss Organ-specific symptoms vary by age Children younger than years most commonly have skin, eye, and joint involvement,