3: Sarcoidosis Flashcards
What is sarcoidosis
Systemic disease caused by chronic caesating granulomatous inflammation
When is sarcoidosis more common
bimodal incidence: 25-35 and 45-65 years-old
In which gender is sarcoidosis more common
females
In which ethnicity is sarcoidosis more common
African American
What alleles is sarcoidosis associated with
HLA DRB1, HLA DQB1
How is 40% of sarcoidosis found
Incidentally on CXR
what are the two manifestations of sarcoidosis if symptomatic
- Acute
- Chronic
explain relationship between acute and chronic sarcoidosis
acute sarcoidosis does not have to happen before chronic sarcoidosis
what is acute sarcoidosis also called
Lofgren syndrome
what is the triad of symptoms in lofgren syndrome
- Erythema nodosum
- Bilateral hilar lymphadenopathy
- Polyarthralgia
what other symptom is present in lofgren syndrome
Swinging fevers
describe time course of lofgren syndrome
Sudden-onset. Resolves in two-years
explain onset of symptoms in chronic sarcoidosis
gradual onset
what will be seen on CXR in chronic sarcoidosis
bilateral hilar lymphadenopathy, pulmonary infiltrates and fibrosis
what are symptoms of sarcoidosis
- progressive dyspneoa
- dry cough
- chest pain
what is most common extra-pulmonary manifestation of sarcoidosis
lymphadenopathy
what may sarcoidosis cause if it affects the eyes
- Keratoconjunctivitis sicca
- Conjunctivitis
- Uveitis
what skin condition is pathognomic for sarcoidosis
Lupus pernio
how does lupus pernio present clinically
Purple discolouration of face, chin, ears
what electrolyte abnormality is associated with sarcoidosis
Hypercalcaemia
why does sarcoidosis cause Hypercalcaemia
Macrophages in granuloma convert vitamin D to its active form increasing calcium concentration
what is a manifestation of sarcoidosis
Heerfordt syndrome
what is the triad of symptoms in heerfordt syndrome
- Uveitis
- Parotitis
- Facial Palsy
what investigation is first line for sarcoidosis
CXR
what will be seen on CXR
- Bilateral hilar lymphadenopathy
- Ground glass opacities
- Fibrosis of upper-zone
what is a mnemonic to remember conditions that cause fibrosis of upper lung zones
CHARTS
what causes fibrosis of upper zones
Coal workers pneumoconiosis Histocytosis/ hypersensitivity pneumonitis Ank spondylitis Radiation TB Sillicosis/sarcoidosis
what causes fibrosis of lower zones
- asbestosis
- Idiopathic pulmonary fibrosis
- Connective tissue disorders (SLE)
- drug-induced (Amiodarone, Belomycin, Methotrexate)
what bloods are ordered in acute sarcoidosis
ESR: raised
what important blood test is raised in chronic sarcoidosis only
ACE
what is ACE
Released by T-lymphocytes in sarcoidosis
what is gold standard for sarcoidosis
Bronchoscopy and biopsy
how will sarcoidosis present in spirometry
restrictive defect
how is acute sarcoidosis managed
bed-rest, analgesia
what medication is given long-term to manage sarcoidosis
prednisolone
