Sarcoidosis

Question 1

What is sarcoidosis

Answer 1

multisystem disorder of unknown aetiology characterised by non-caseating granulomas

Question 2

Population most commonly affected by sarcoidosis

Answer 2

More common in young adults and in people of African descent

Question 3

Acute features of sarcoidosis

Answer 3

erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia

Question 4

Skin manifestation of sarcoidosis

Answer 4

Lupus pernio
Erythema nodosum
Granulomas develop in scar tissue

Question 5

What causes hypercalcaemia in sarcoidosis

Answer 5

Macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

Question 6

Syndromes associated with sarcoidosis

Answer 6

Lofgren’s syndrome
Mikulicz syndrome
Heerfordt’s syndrome

Question 7

What is lofgren’s syndrome

Answer 7

acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia

Question 8

Sarcoidosis ix

Answer 8

Serum ACE 
May show hypercalcaemia 
Raised ESR 
CXR 
Raised serum soluble interleukin-2 receptor

Question 9

What might spirometry show in sarcoidosis

Answer 9

May show a restrictive defect

Question 10

How does sarcoidosis affect the lungs

Answer 10

Mediastinal lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules

Question 11

How does sarcoidosis affect the liver

Answer 11

Liver nodules
Cirrhosis
Cholestasis

Question 12

How does sarcoidosis affect the eyes

Answer 12

Uveitis
Conjunctivitis
Optic neuritis

Question 13

What is lupus pernio

Answer 13

Raised purple skin lesions commonly on cheeks and nose

Question 14

How does sarcoidosis affect the heart

Answer 14

Bundle branch block
Heart block
Myocardial muscle involvement

Question 15

How does sarcoidosis affect the kidneys

Answer 15

Kidney stones (due to hypercalcaemia)
Nephrocalcinosis
Interstitial nephritis

Question 16

How does sarcoidosis affect the CNS

Answer 16

Nodules
Pituitary involvement (diabetes insipidus)
Encephalopathy

Question 17

How does sarcoidosis affect the PNS

Answer 17

Facial nerve palsy

Mononeuritis multiplex

Question 18

What is mononeuritis multiplex

Answer 18

painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas.

Question 19

How does sarcoidosis affect the bones

Answer 19

Arthralgia
Arthritis
Myopathy

Question 20

Gold standard for confirming sarcoidosis

Answer 20

Histology from a biopsy

Question 21

Treatment for sarcoidosis in patients with no or mild symptoms

Answer 21

No treatment is considered as first line in patients with no or mild symptoms as the condition often resolves spontaneously.

Question 22

1st line treatment for sarcoidosis when required

Answer 22

Oral steroids are usually first line where treatment is required and are given for between 6 and 24 months. Patients should be given bisphosphonates to protect against osteoporosis whilst on such long term steroids.
Second line options are methotrexate or azathioprine

Question 23

Intervention in severe pulmonary disease in sarcoidosis

Answer 23

Lung transplant