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Diagnosed with Sarcoidosis, lymph nodes, palpitations. Recommendation for best possible treatment?

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Practicing since : 2003
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i am a 36 year old male of lebanese descent diagnosed with sarcoidosis since march of this year.

i have presently lymph node involvement only.

2 weeks ago i did a treadmill test and it was perfect with no arrhythmias.

but i have been having palpitations since 3 days ago, around 3 or 4 every minute.

i cannot go to the usa because shamefully i have not been granted a visa.

i need help in the form of advice as where can i get the medical attention required for my condition (sarcoidosis), and now my current palpitations which may or may not be related to the sarcoidosis.

i am quite frustrated and afraid because no one seems to be able to get me an acceptable answer.

please recommend where in the world (apart from the usa) i can get the best attention possible for my condition ??

thank you
Posted Tue, 8 May 2012 in Lung and Chest disorders
Answered by Dr. Gyanshankar Mishra 3 hours later

Thank you for posting your query.

After going through your history, I would like to make the following comments:

1. Sarcoidosis is a multisystem inflammatory disease of unknown aetiology that predominantly affects the lungs and intrathoracic lymph nodes. I suppose by lymph nodes you are referring to intra thoracic lymph nodes.

2. For pulmonary disease, asymptomatic PFT (pulmonary function test) and/or CXR (chest X ray) abnormalities are not an indication for treatment. Thus if you have no respiratory symptoms apart from intrathoracic lymph nodes, then it need not be treated.

3. Being an immunological disease, it is not "curable" but the disease activity can be controlled very well with corticosteroids and immunosuppressants. Non steroidal anti-inflammatory drugs (NSAIDS) can be used for symptomatic management.

4. At the time of diagnosis, I suppose you have undergone the following investigations as they are important for diagnosis of sarcoidosis:
a. Fine needle aspiration cytology (FNAC) / Biopsy from the lesion
b. Serum angiotensin converting enzyme levels (ACE levels).
c. Serum and Urinary calcium levels
d. Tuberculin skin testing
e.Chest X XXXXXXX / ct thorax
f. Pulmonary function test
g. Bronchoscopy if required

5. Currently, I assume that you are not on any medications. The following investigations need to be done to rule out cardiac involvement:
•     Electrocardiogram (ECG)
•     2D Echocardiography
•     Cardiac Computerized Tomography Scanning (CT Scan) will help.
Since you are having these symptoms for the last 3 days, you need to get yourself evaluated in detail for the same.

6. For proper evaluation of your cardiac status, you could visit a cardiologist. However the primary treatment of your sarcoidosis should be done by a pulmonologist.

7. Also, I would like to bring to your attention that about half of the patients with sarcoidosis do not require any treatment.

8. Prominent physicians who can treat sarcoidosis are present in about 38 countries (NON US countries like Australia, UK, Canada, India, France, etc.) around the globe. Please do let me know some locations / countries that would suit you so that I can give you the appropriate details.

I hope I have answered your query. Please accept my answer if you have no follow up queries. I will be glad to answer any follow up queries.

Take care.


Dr. Gyanshankar Mishra
Above answer was peer-reviewed by
Follow-up: Diagnosed with Sarcoidosis, lymph nodes, palpitations. Recommendation for best possible treatment? 56 minutes later

thank you for your excellent reply !

if you had to choose THE BEST doctor for sarcoidosis anywhere in the world (apart from usa) who would it be ?

also let me know who you would choose in france or uk ?

God bless you.
Answered by Dr. Gyanshankar Mishra 5 hours later

Thanks for the follow up.

Most of the Sarcoid specialists are Pulmonologists. Here is a list of sarcoid specialists in UK & France:


DuBois, R. M.
Royal Brompton Hospital
Brompton Road
London, England

Sarcoidosis Clinic
Royal Free Hospital
Pond Street
Hampstead LONDON NW3

Department of Pathology University of Wales College of Medicine & Section of Respiratory Medicine Llandough Hospital Penarth, South Glamorgan, Wales


Cordier, Professor Jean-Francois
Hospital XXXXXXX Pradel Service de Pneumologique
59 Boulevard Pinel
F-0000 Lyon, France

Its a hard fact that some of the best Sarcoidosis experts are based in US (Dr. OP XXXXXXX Dr. Baughman).

Some prominent sarcoid specialists in world are as follows:

Prof. Dr. U. Costabel, MD, PhD . Professor of Medicine and Chief of the Division of Pneumology and Allergology at the Ruhrlandklinik in Essen, Germany.

Prof. Dr. M. Drent, MD, PhD. professor of interstitial lung diseases (ild) at the Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, the Netherlands.

Cesare Saltini, Professor MD, Head of the Division of Respiratory Diseases, University of Rome (Tor Vergata) Rome.

Hope I have answered your query. I will be glad to answer follow up query if any.
Please accept my answer if there are no further queries.


Dr. Gyanshankar Mishra
Above answer was peer-reviewed by
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