Sarcoidosis

Question 1

Clinical features:

Answer 1

may be asymptomatic (one-third)

onset usually 3rd or 4th decade (but any age)

bilateral hilar lymphadenopathy (on CXR)

cough

fever, malaise, arthralgia

erythema nodosum

ocular lesions (e.g. anterior uveitis)

other multiple organ lesions (uncommon)

overall mortality 2–5%

Question 2

Diagnosis

Answer 2

Histological evidence from biopsy specimen,

• usually trans-bronchial biopsy
• —best with video-assisted thoracoscopy.

Supporting evidence:

elevated s. ACE level + s. calcium

PFTs: restrictive pattern; impaired gas transfer in advanced cases

Question 3

Treatment

Answer 3

Sarcoidosis may resolve spontaneously

• hilar lymphadenopathy without lung involvement does not require Rx

Indications for treatment with corticosteroids:

no spontaneous improvement or worse after 3–6 mths

symptomatic pulmonary lesions

eye, CNS and other systems involvement

hypercalcaemia, hypercalcuria

erythema nodosum with arthralgia

persistent cough

Question 4

Corticosteroid treatment

Answer 4

Prednisolone 30 mg daily for 6 wks,

• then reduce to lowest dose which maintains improvement
• e.g. 10–15 mg for 6–12 mths

Prednisolone 20–30 mg for 2 wks

• for erythema nodosum of sarcoidosis