18. Sarcoidosis Flashcards
What is a granuloma?
A collection of macrophages that have walled off a perceived area of disease which is actually an area of healthy tissue.
What groups are most likely to get sarcoidosis?
those aged 20-40
woman
african-carribeans
What are the signs of sarcoidosis?
CXR- 90% have bilateral hilar lymphadenopathy, may also have pulmonary infilatrates/fibrosis.
What are the symptoms of sarcoidosis?
Dry cough
Progressive dyspnoea
Decreased exercise tolerance
Chest pain
What are the symptoms of acute sarcoidosis?
Fever, erythema nodosum, polyarthralgia, bilateral hilar lymphadenopathy.
What is erythma nodosum
swollen fat lumps under the skin. Present as circular patches of inflammation
What non pulmonary signs may be associated with sarcoidosis?
lymphadenopathy,splenomegaly, hepatomegaly
uveitis,conjunctivitis, glaucoma,
enlargement of lacrimal and parotid glands
bell’s palsy, neuropathy, meningitis, space occupying lesions
cardiomyopathy, arrythmias, hypercalceamia, renal stones, pituitary dysfunction
What tests should be ordered?
ESR, FBC, LFT, Serum ACE, Ca, Immunoglobulins
Urine calcium
Opthamology assessment
What do investigations show?
CXR- staging
Lung function tests- impaired
BAL- increased lymphocytes, increased neutrophils
CT/MRI- assessing pulmonary disease/neurosarcoidosis
What is the management for acute sarcoidosis?
Bed rest, NSAIDS
What is the management for chronic sarcoidosis?
BHL- dont need treatments
Corticosteroids indicated if:
- parychymal lung disease
- Uveitis
- Hypercalcaemia
- Neurological or cardiac involvement
What other therapies may be needed for sarcoidosis?
IV methyprednisolone in secere disease
Immunosuppersants in severe disease
Anti TNFa therapy may be tried
Lung transplantation
What are some important differentials for bilateral hialr lymphadenopathy?
Sarcoidosis TB Malignancy Organic dust disease Hypersensitivity pneumonitis Langerhans' cell histiocytosis
