Can Sarcoidosis Cause Fever?
Yes, sarcoidosis can cause fever as part of its systemic inflammatory presentation, though bilateral hilar adenopathy without B symptoms (including fever) is more typical of the disease. 1
Constitutional Symptoms in Sarcoidosis
Fever is a recognized constitutional symptom of sarcoidosis, occurring alongside other systemic manifestations:
- Systemic inflammatory symptoms include subfebrile or febrile temperatures, night sweats, weight loss, diminished physical reserve, and fatigue 2
- Constitutional symptoms such as fever, unintentional weight loss, and fatigue are well-documented manifestations that patients with sarcoidosis can exhibit 3
- B symptoms (fevers, night sweats, and weight loss) are specifically mentioned in diagnostic guidelines, though their absence in the context of bilateral hilar adenopathy is considered strongly associated with sarcoidosis 1
Clinical Context and Patterns
The presence and pattern of fever in sarcoidosis varies by disease presentation:
- Acute presentations can include high fever (up to 39-39.9°C) with diffuse interstitial pulmonary infiltrates and marked respiratory compromise 4
- Löfgren's syndrome, a specific acute phenotype characterized by bihilar lymphadenopathy, ankle arthritis, and erythema nodosum, is considered diagnostic of sarcoidosis and may present with fever 1, 5
- Chronic sarcoidosis can be asymptomatic despite extensive radiological changes, making fever less prominent in these cases 5
Important Diagnostic Considerations
When evaluating fever in a patient with known or suspected sarcoidosis:
- Exclude alternative diagnoses first, as the diagnosis of sarcoidosis requires ruling out other causes of granulomatous disease, including infections 1, 3
- Consider drug-induced fever if the patient is on immunosuppressive therapy, as medications like azathioprine can cause fever independent of disease activity 6
- Assess for organ involvement requiring urgent treatment, particularly cardiac or neurologic manifestations, which may present with systemic symptoms including fever 3, 2
Clinical Pitfall
The most critical pitfall is assuming fever in a patient with sarcoidosis is always due to the disease itself—infectious complications must be systematically excluded, particularly in patients receiving immunosuppressive therapy 1, 2. Additionally, atypical symptoms such as fever and productive cough should trigger infectious disease consultation in patients being evaluated for pulmonary manifestations 1.