FIGURE 99.8 Sarcoid A 9-year-old child with hepatosplenomegaly but no pulmonary complaints The chest film shows interstitial lung disease with hilar adenopathy Diagnosis of sarcoidosis in children is challenging because it is rare and findings may be subtle For pediatric patients with multisystem complaints, however, sarcoidosis should be considered In particular, pulmonary disease associated with rash, uveitis, or arthritis is suggestive However, because lung disease can remain clinically silent, respiratory complaints need not be present at the time of initial presentation Alternatively, unexplained intrathoracic adenopathy may prompt further investigation, leading to the diagnosis The diagnosis is ultimately made histologically Biopsy of a lymph node or other easily accessible organ will demonstrate noncaseating epithelioid cell granulomas These findings may need to be further differentiated from other rheumatologic or infectious diseases that can have similar histopathology Corticosteroid treatment is the most commonly used therapy for sarcoidosis However, because the disease resolves spontaneously in a substantial proportion of patients, there is often debate about whether steroids are routinely indicated Steroids may be administered to children with significant lung or eye lesions In addition, those with cardiac, CNS, or multiorgan system involvement usually warrant therapy Corticosteroids seem to be effective as acute therapeutic agents but have little effect on permanent organ derangements, including chronic lung disease For many patients, the prognosis in sarcoidosis is favorable, although