Pulmonary Sarcoidosis

Question 1

What is pulmonary sarcoidosis?

Answer 1

A disorder resulting in non-caseated granulomas in one or more organs e.g lungs
These granulomas can occur most commonly in the lymph glands so hilar lymph nodes are affected/involved (hilar lymphadenopathy)

Question 2

Describe the epidemiology of sarcoidosis?

Answer 2

Prevalence highest in Northern Europe
20-40yrs
More common in women
Afro-Caribbean’s are affected more frequently and severely than Caucasians

Question 3

Pulmonary features of sarcoidosis

Answer 3

Bilateral hilar infiltrates

Fibrosis

Question 4

Outline the 4 stages of pulmonary sarcoidosis on a CXR

Answer 4

0- normal
1- bilateral hilar lymphadenopathy
2- bilateral hilar lymphadenopathy and pulmonary infiltrates
3-pulmonary infiltrates only
4- pulmonary fibrosis (may be pleural involvement)

Question 5

Describe the clinical features of acute sarcoidosis

Answer 5

Fever
Erythema nodosum
Polyarthralgia
Bilateral hilar lymphadenopathy 
Also called Löfgren syndrome

Question 6

What tests would you order in pulmonary sarcoidosis and what results would you expect?

Answer 6

Bloods- increased ESR, lymphopenia, increased LFTm increased serum ACE, increased Ca and immunoglobulins
24hr urine- increased Ca
CXR
ECG may show arrhythmias or BBB
Lung function tests- may be normal or show decreased lung vols, impaired gas exchange
Bronchoalveolar lavage- increased lymphocytes in active disease and increased neutrophils in pulmonary fibrosis

Question 7

Describe the management of pulmonary sarcoidosis

Answer 7

patients with bilateral hilar lymphadenopathy alone- do not treat
acute sarcoidosis can be treated with bedrest and NSAIDs

Corticosteroids if: parenchymal lung disease (infiltrates) Uveitis, Hypercalcaemia, neuro and cardiac involvement
Prednisolone 40mg/24hr PO for 4-6 weeks then taper dose over 1 year.