Sarcoidosis in an Athlete

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by “noncaseating granulomas” in different organs. Clinical signs are variable and dependent on the organ involved. Although it is often asymptomatic in athletes, considering the high level of athletic performance and the related risks due to the potential heart involvement, a particular diagnostic flow-chart to consider some other diagnoses is required. The present case report aimed to focus on the clinical approach in case of a progressive weakness associated with a reduction in global performance of an athlete. CASE PRESENTATION: Since October 2008 a 33-year-old Scandinavian professional soccer player has shown splitting headache, fever and impaired exercise tolerance. Despite some clinical aspects and symptoms that could address diagnosis of granulomatosis according to the current guidelines, the first hypothesis was indicative of a possible viral infection. Therefore, the athlete had received a drug-therapy resolving the headache and fever. However, because of the persisting weakness, several other clinical possibilities were evaluated following a more complete diagnostic flow-chart, blood and instrumental exams. CONCLUSION: This case report focuses on the substantial absence of symptoms during the granulomatosis disease, which makes the differential diagnosis to be often complicating. Indeed, several additional exams are required in order to establish the presence of “Non-evolutive sarcoidosis- stage I”, for which the therapy is not mandatory.