Sarcoidosis Flashcards
Age of onset of sarcoidosis:
Bimodal 25-35 and 45-65
Which population has highest incidence of sarcoidosis and tend to have more severe/progressive disease?
African Americans
What is the basic pathogenesis of sarcoidosis?
Genetic predisposition (unknown which gene) + environmental trigger—>
multisystem granulomatous disease cuased by upregulation of CD4+ Th1 cells
Patients being treated for _____ with _____ have been reported to get drug induced sarcoidosis (2 answers)
- Hep C with IFN-alpha or ribavirin
- HIV pts on HAART
If you diagnose a patient with sarcoid, what labs must you order?
all patients must get:
CXR
PFT’s
regular eye exams
What is the classic clinical presentation of sarcoidosis?
red-brown or erythematous papules and plaques w/ characterstic “apple jelly” color with diascopy
- lesions typically lack secondary changes
Less common presentations:
- hypopigmented, ichthyosiform, angiolupoid (prominent telangiectasias), psoriasiform, annular, verrucous, cictricial alopecia, erythrodermic
lesions of sarcoidosis have a prediliction for which areas of body?
face! especially lips and nose, neck, and upper half of body
Lesions of sarcoid often arise within _____
preexisting scars, tattoos, piercings
What is the most important non-specific manifestation of sarcoid and why?
erythema nodosum as it predicts a benign, self-limited course
What other areas of involvement are we concerned with for patient with sarcoidosis besides the skin?
lungs: alveolitis, bronchiolitis, “honeycombing” of lung w/ fibrosis and bronchiectasis
Lymphadenopathy: usually hilar, asymptomatic
Ocular: anterior uveitis, retinitis, conjunctivitis, can lead to blindness!
Hypercalcemia: due to calcitriol synthesis by sarcoidal granulomas, can lead to nephrocalcinosis and renal failure
What causes hypercalcemia in sarcoidosis?
due to calcitriol synthesis by sarcoidal granulomas
Why do we need to recommend regular eye exams for patient with sarcoidosis?
20-50% get anterior uveitis, retinintis, lacrimal inflammation, conjunctivitis—-> can lead to blindness!
Histopath of sarcoid:
superficial and deep dermis packed w/ nodules of well-formed, non-caseating, “naked epithelioid granulomas” (lacking significant inflammatory rim of lymphocytes or plasma cells)
- asteroid bodies (star shaped eosinophilic inclusions of collagen)
what lab value is useful for monitoring response to treatment in sarcoidosis?
ACE level
First line tx for systemic sarcoidosis?
oral prednisone
