Sarcoid

Question 1

Lofgren syndrome (4)

Answer 1

Hilar adenopathy
Fever
Arthralgia
Erythema nodosum

Question 2

Heerfordt sydnrome

Answer 2

Uveitis
Fever
Parotid gland enlargement

Question 3

BAL findings typical for sarcoid?

Answer 3

CD4/CD8 over 3.5 (but only in 60%)

Question 4

CT findings in sarcoid?

Answer 4

Subpleural reticulonodular changes
Peribronchial thickening
UPPER LOBE PREDOMINANT INFILTRATES (also hypersens pneumonitis, silicosis, langerhand cell histiocytosis, TB, pneumocystis)

Question 5

When do you treat sarcoid?

Answer 5

When there are symptoms

Question 6

Staging- describe

Answer 6

0 normal
1 hilar LN but normal lung parenchyma
2 hilar LN + abnormal parenchyma
3  no LN but abnormal lung parenchyma
4 Parenchymal changes with fibrosis and architectural distortion

Once 3, less than 1/3 spontaneously remit.

Question 7

Classic cranial nerve palsy?

Answer 7

Seventh

Question 8

What is the most specific skin finding?

Answer 8

Lupus pernio
-chronic raised purplish lesion on face or nose- pathognomonic

Can also see erythema nodosum
Paniculitis lower limbs- painful nodules

Question 9

Cardiac sarcoid- what happens?

Answer 9

Heart block and sudden cardiac death

Can look with cardiac MRI

Question 10

Hypercalcaemia- how??

Answer 10

noncaseating granulomas secrete 1,25 vitamin D–>hypercalcaemia and hypercalciuria via enhanced GI absorption.

Question 11

ACE sensitivity?

Answer 11

60% at diagnosis
spec 70%
NO CLEAR PROGNOSTIC VALUE

ACEi articficially decrease level
Leprosy, miliary TB, hyperthyroidism and Gauchers disease also increase.

Question 12

Most common PFT abnormality

Answer 12

Reduced DLCO 15-20%

If DLCO goes below 60 or sesat to below 90 on 6MWT, then they are 12 x more likely to get pulmonary hypertension!

Question 13

When would you treat sarcoid?

Answer 13

If extra-pulmonary sarcoid
Deterioration in PFTs
Troubling resp symptoms

Steroids 0.3-0.6 mg/kg and taper over 1 year

MTX or AZA as steroid sparing or steroid nonresponsive agents.

Topical steroids ok for ocular disease

Can use inhaled CS for bronchial disease if mild cough or

Question 14

MRI findings in cardiac sarcoid?

Answer 14

T1-weighted (cine) imaging –>wall motion abnormalities, hypertrophy due to possible infiltrative disease, wall thinning, or heart failure.
Late gadolinium enhancement –> assesses fibrosis or scar and may represent chronic rather than active disease

Look for non vascular territory involvement.