FN: Sarcoidosis

Question 1

Definition

Answer 1

Multisystem granulomatous disorder of unknown cause

Question 2

Epidemiology

Answer 2

􏰀 Age: 20-40yrs
􏰀 Sex: F>M
􏰀 Geo: Afro Caribbean
􏰀 HLA-DRB1 and DQB1 alleles

Question 3

Clinical features pneuomic

Answer 3

GRAULOMAS
􏰀 In 20-40% the disease presents incidentally on CXR
􏰀

Question 4

acute sarcoidosis features

Answer 4

Acute sarcoidosis: EN, fever, polyarthralgia, BHL

Question 5

Pneumonic

Answer 5

General
Respiratory
Arthralgia
Neurological
Urine
Low Hormones
Ophthamology
Myocardial
Abdominal
Skin

Question 6

General features

Answer 6

􏰀 Fever
􏰀 Anorexia and ↓ wt.
􏰀 Fatigue
􏰀 Lymphadenopathy and HSM

Question 7

Respiratory features

Answer 7

􏰀 Upper: otitis, sinusitis
􏰀 Lower (seen in 90%)
􏰁 Dry cough, SOB, chest pain, ↓ lung function
􏰁 Stage 1: BHL
􏰁 Stage 2: BHL + peripheral infiltrates
􏰁 Stage 3: Peripheral infiltrates alone
􏰁 Stage 4: Progressive mid-zone fibrosis ̄c bullae

Question 8

Arthralgia features

Answer 8

􏰀 Polyarthralgia 􏰀 Dactylitis

Question 9

Neurological features

Answer 9

􏰀 Peripheral and cranial polyneuropathy (esp. Bell’s palsy)

􏰀 Meningitis, transverse myelitis, SOL

Question 10

Urine features

Answer 10

􏰀 ↑Ca → Renal stones, nephrocalcinosis, DI

Question 11

Low hormones features

Answer 11

􏰀 Pituitary dysfunction: e.g. amenorrhoea

Question 12

Opthalmological

Answer 12

􏰀 Uveitis
􏰀 Keratoconjunctivitis
􏰀 Sicca / Mikulicz / Sjogrens syndrome

Question 13

Myocardial features

Answer 13

􏰀 Restrictive cardiomyopathy 2O to granulomas + fibrosis

􏰀 Pericardial effusion

Question 14

Abdominal features

Answer 14

􏰀 Hepatomegaly + cholestatic LFTs 􏰀 Splenomegaly

Question 15

Skin features

Answer 15

􏰀 􏰀
EN: painful erythematous nodules on shins (paniculitis) Lupus pernio: raised, dusky purple plaque on nose, cheek, fingers

Question 16

Ix Bloods show

Answer 16

􏰀 ↑ESR
􏰀 ↑Ca
􏰀 Lymphopenia 􏰀 ↑seACE
􏰀 ↑Ig
􏰀 ↑LFTs

Question 17

Tuberculin skin test shows

Answer 17

􏰀 Negative in 2/3

Question 18

Lung function tests

Answer 18

􏰀 Restrictive pattern ̄c ↓FVC

􏰀 ↓ transfer factor

Question 19

Tissue biopsy

Answer 19

􏰀 Lung, LNs, skin nodules, liver

􏰀 Diagnostic: non-caseating granulomas

Question 20

Treatment acute vs chronic

Answer 20

􏰀 Pts.  ̄c asymptomatic BHL do not require Rx.
􏰀 Acute sarcoidosis
􏰁 Usually resolves spontaneously
􏰁 Bed rest and NSAIDs
􏰀 Chronic sarcoidosis
􏰁 Steroids: pred 40mg/d for 4-6wks
􏰁 Additional immunosuppression: methotrexate,
ciclosporin, cyclophosphamide

Question 21

Prognosis

Answer 21

􏰀 60% ̄c thoracic sarcoidosis resolve over 2yrs
􏰀 20% respond to steroids
􏰀 20% no improvement despite Rx

Question 22

BHL Differential

Answer 22

􏰀 Sarcoidosis
􏰀 Infection: TB, mycoplasma
􏰀 Malignancy: lymphoma, carcinoma 􏰀 Interstitial disease: EAA, silicosis

Question 23

Granulomatous Disease Differential

Answer 23

􏰀 Infections: TB, leprosy, syphilis, crypto, schisto
􏰀 AI: PBC
􏰀 Vasculitis: GCA, PAN, Wegener’s, Takayasu’s
􏰀 Idiopathic: Crohns, Sarcoid
􏰀 Interstitial lung: EAA, silicosis