Sarcoidosis Flashcards
what is sarcoidosis
- granulomatous inflammatory condition usually assc. w/ chest symptoms
- also has multiple extra-pulmonary manifestations e.g. erythema nodosum and lymphadenopathy
what are granulomas
nodules of inflammation full of macrophages
when are the two spikes of incidence of sarcoidosis
- young adulthood
- appx age 60
what people are more often affected by sarcoidosis
- women
- black people
where on the body may nodules appear to suggest erythema nodosum
shins
what organs are affected in sarcoidosis
- lungs (affecting >90%)
- liver
- eyes
- skin
- heart
- kidneys
- CNS
- PNS
- Bones
what lung pathology might be seen as a result of sarcoidosis
- mediastinal lymphadenopathy
- pulmonary fibrosis
- pulmonary nodules
give some systemic symptoms of sarcoidosis
- fever
- fatigue
- weight loss
what liver pathology might be seen as a result of sarcoidosis
- liver nodules
- cirrhosis
- cholestasis
what eye pathology might be seen as a result of sarcoidosis
- uveitis
- conjunctivitis
- optic neuritis
what skin pathology might be seen as a result of sarcoidosis
- erythema nodosum
- lupus pernio
- granulomas develop in scar tissue
what heart pathology might be seen as a result of sarcoidosis
- bundle branch block
- heart block
- myocardial muscle involvement
what kidney pathology might be seen as a result of sarcoidosis
- kidney stones (due to hypercalcaemia)
- nephrocalcinosis
- interstitial nephritis
what CNS pathology might be seen as a result of sarcoidosis
- nodules
- pituitary involvement (diabetes insipidus)
- encephalopathy
what PNS pathology might be seen as a result of sarcoidosis
- facial nerve palsy
- mononeuritis multiplex
what bone pathology might be seen as a result of sarcoidosis
- arthralgia
- arthritis
- myopathy
what’s is Lofgren’s syndrome
specific presentation of sarcoidosis…
triad of:
- erythema nodosum
- bilateral hilar lymphadenopathy
- polyarthralgia
give some differential diagnoses of sarcoidosis
- tuberculosis
- lymphoma
- hypersensitivity pneumonitis
- HIV
- toxoplasmosis
- histoplasmosis
what results might be seen in blood tests in suspected sarcoidosis
- ^ serum ACE
- hypercalcaemia
- ^ serum soluble interleukin-2 receptor
- ^ CRP
- ^ immunoglobulins
what blood test result is often used as a screening test for sarcoidosis
^ serum ACE
what imaging results would be seen in sarcoidosis
- CXR –> hilar lymphadenopathy
- high resolution CT thorax –> hilar lymphadenopathy and pulmonary nodules
- MRI –> CNS involvement
- PET scan –> active inflammation in affected areas
what is the gold standard for confirming diagnosis of sarcoidosis
histology from biopsy
how is a biopsy obtained for sarcoidosis
bronchoscopy w/ ultrasound guided biopsy of mediastinal lymph nodes
what would be seen histologically to suggest sarcoidosis
non-caseating granulomas w/ epitheliod cells
what tests could be done to show other organ involvement
- U&Es –> kidney
- urine dipstick or urine albumin-creatinine ratio to look for proteinuria –> nephritis
- LFTs –> liver
- opthalmology –> eye
- ECG and echo –> heart
- ultrasound abdomen –> liver and kidney
what is the treatment of sarcoidosis
- no treatment considered as first line in Px w/ no or mild symptoms as condition often resolves spontaneously
- oral steroids usually first line where treatment req. given for between 6-24 months
- 2nd line options –> methotrexate or azathioprine
- lung transplant in severe pulmonary disease
what should Px be given while taking long term oral steroids and why
Px given bisphosphonates to protect against osteoporosis
what is the prognosis of sarcoidosis
- spontaneously resolves within 6 months in around 60% of px
- can progress w/ pulmonary fibrosis and pulmonary hypertension in small number of px
- death in sarcoidosis is usually when it affects the heart or CNS
