Case Study 2 Flashcards
A 30 year old Afro-Caribbean woman presents to her GP with a six-month history of exertion dyspnoea and a painful red lesion on her shin. She also complains of dry itchy eyes. A clinical diagnosis of sarcoidosis is made. What condition is the painful lesion most likely to be?
Erythema nodosum
Give 3 other extra-pulmonary areas which might present manifestations of sarcoidosis
- skin
- neurological
- eyes
- salivary and lacrimal glands
- joints
- abdomen
- renal
- lymph nodes
- cardiovascular system
Give a manifestation of sarcoidosis on the skin
- lupus pernio
- sarcoid infiltration of the skin
Give a neurological manifestation of sarcoidosis
- peripheral neuropathy
- cranial nerve palsies
- aseptic meningitis
- hypopituitarism
Give a manifestation of sarcoidosis in the eyes
- anterior uveitis
- choroiretinitis
Give a manifestation of sarcoidosis in the salivary and lacrimal glands
Sicca syndrome
Give a manifestation of sarcoidosis on the joints
Arthralgia
Give a manifestation of sarcoidosis on the abdomen
Hepatosplenomegaly
Give a manifestation of sarcoidosis in the renal system
- renal stones
- hypercalciuria and associated nephrocalcinosis
Give a manifestation of sarcoidosis in the lymph nodes
Lymphadenopathy
Give a manifestation of sarcoidosis in the CVS
- cor pulmonale
- conduction system disease
Give five essential investigations into sarcoidosis
- CXR
- transbronchial biopsy and broncho-alveolar lavage
- liver biopsy
- respiratory function tests
- serum ACE
- Kveim test
- tuberculin test
What is sarcoidosis?
A common, multi-system granulomatous disorder which usually presents between 25-35 years of age
In what race will sarcoidosis have a more severe presentation and malignant prognosis?
Afro-Caribbean
Give a characteristic of sarcoidosis on CXR
Bilateral hilar lymphadenopathy
The course and prognosis of sarcoidosis can be inferred by
the mode of presentation
Acute onset in young adults with associated erythema nudosum usually signifies
a self-limiting disorder
Later, more insidious onset in middle age leads to
a progressive disorder with multi system fibrosis
Pulmonary sarcoid is classified by the radiological changes seen on CXR into four stages. What is the first stage?
Clear CXR
What is the second stage of pulmonary sarcoid on CXR?
Bilateral hilar and mediastinal lymphadenopathy
What is the third stage of pulmonary sarcoid on CXR
Bilateral hilar and mediastinal lymphadenopathy with associated pulmonary infiltration
What is the fourth stage of pulmonary sarcoid on CXR?
Pulmonary infiltration without hilar lymphadenopathy
When are steroids recommended for use in sarcoidosis?
For stage two and three of the pulmonary disease and for eye and cardiac involvement
