46 - Sarcoidosis Case Study Flashcards
What is sarcoidosis?
Sarcoidosis is the growth of tiny collections of inflammatory cells in different parts of your body — most commonly the lungs, lymph nodes, eyes and skin.
An inflammatory process that produces granulomas, which may be in various organs.
What causes the symptoms of sarcoidosis?
The symptoms of sarcoidosis stem from the clumping of granulomas, which affect its ability to function.
What groups of people are affected by sarcoidosis most commonly?
More common in African Americans
- AA: 40/100,000
- White: 1/100,000
More common in young people
What are the two phases of sarcoidosis?
Active and inactive
Describe the active phase of sarcoidosis
Active phase: the granulomas form and grow in this phase, symptoms develop and scar tissue can form.
Describe the inactive phase of sarcoidosis
Inactive phase: inflammation subsides, the granulomas shrink or stay the same size. But the scars remain and continue to produce symptoms.
What are the five disease stages of sarcoidosis?
Stage 0 Stage I Stage II Stage III Stage IV
Describe stage 0 of sarcoidosis
Normal
Describe stage I of sarcoidosis
Isolated bilateral thoracic lymphadenopathy
Lymphadenopathy = enlarged lymph nodes
Describe stage II of sarcoidosis
Bilateral hilar lymphadenopathy plus lung parenchymal infiltration
Lymphadenopathy = enlarged lymph nodes
Parenchymal infiltration = lung tissue edema accumulation
Describe stage III of sarcoidosis
Parenchymal infiltration
Parenchymal infiltration = lung tissue edema
Describe stage IV of sarcoidosis
Advanced parenchymal disease, including overt pulmonary fibrosis
The inflammatory process and edema leads to fibrosis of lung tissue
What are the pulmonary symptoms associated with sarcoidosis?
- Hemoptysis (coughing up blood)
- Shortness of breath
- Dry cough
- Wheezing
- Pain in the chest
Describe the progression of chest cavity symptoms
There is a slow progression of manifestations in the chest cavity
What happens to the lymph nodes in sarcoidosis?
- Enlarged tender lymph nodes (present within the neck, chest, chin, armpits, and groin)
What happens to the skin in sarcoidosis? What is the name for it?
Erythema nodosum - Various types of bumps, ulcers (present near the nose, eyes, back, arms, legs, and scalp) usually itchy painful bumps (at the ankles and shin)
This is very NON-specific… Occurs in many different disorders
What do we call the skin condition in sarcoidosis if it becomes disfiguring?
Lupus pernio
- disfiguring sores (nasal passages, cheeks, ears, eyelids, and fingers)
What do we see in sarcoidosis when there is ocular involvement?
- Optic neuritis
- Keratoconjunctivitis
- Uveitis
What is uveitis?
- Burning, itching, tearing, pain
- Red eye
- Sensitivity
- Dryness
- Floaters
- Reduced color vision
What types of things would you see if there was liver involvement in sarcoidosis?
Liver
- fever
- fatigue
- enlargement
- pain
What types of things would you see if there was heart involvement in sarcoidosis?
Heart
- irregular heartbeat (arrythmias), CHF
- loss of consciousness
- swelling of legs
- sudden death
What types of things would you see if there was musculoskeleteal involvement in sarcoidosis?
Musculoskeletal
- joint stiffness and swelling
- joint pain
- muscle aches
- muscle pain
- painful arthritis (clears up in weeks)
- painless arthritis (last months-years)
What types of things would you see if there was bone involvement in sarcoidosis?
Bone
- painless lesions in the bone
- painless swelling (fingers)
- anemia
What types of things would you see if there was nervous system involvement in sarcoidosis?
Nervous system
- headaches
- weakness and numbness
- symptoms resembling Bells palsy
- paralysis
What is an uncommon but serious manifestation of sarcoidosis?
Neuro-sarcoidosis is an uncommon but serious manifestation of sarcoidosis, affecting about 5-10% of patients
What are the most common manifestations of neuro-sarcoidosis?
Neuro-sarcoidosis
- myelopathy (pathology of the spinal cord)
- cranial neuropathy (i.e. Bells palsy)
- encephalopathy (pathology of the brain)
What is Heerfordt syndrome?
- Uveitis
- Parotid gland enlargement
- Fever
- Cranial neuropathy (CN VII usually)
What types of tests would you order for a patient who you suspected sarcoidosis?
- CBC with diff
- Sed rate
- Chest x-ray
What are you looking for on a CBC?
White blood cell count
- Normal is 4-11
- Elevation means there is an infectious process going on
What is a sed rate?
A sedimentation rate is common blood test that is used to detect and monitor inflammation in the body
What would you be looking for on a chest x-ray?
- Granulomas
- Inflammation
- Hilar fullness
What other tests might you order further on?
- CT scan
- Mediastinoscopy with lymph node and lung biopsy
What is the gold standard for diagnosis?
Lung biopsy - then you can really see what is going on
What are possible causes of sarcoidosis?
- Genetic
- Infectious
- Vitamin D dysregulation
- Hyperprolactinemia
- Autoimmune
It could be one or multiple of these disease processes… Unsure
What infectious agent can be isolated in sarcoidosis?
Propinonobacterium
What vitamin D dysreculation can occur
1,25-dihydroxyvitamin D