Sarcoidosis Flashcards
What is sarcoidosis?
A systemic inflammatory disease of unknown etiology.
What is the rule in order to diagnose a patient with sarcoidsosi?
Mutlisystem disorder that requires the involvement of => 2 or more organs for diagnosis.
What is a special finding that signals for sarcoidosis?
Presence of noncaseating granulomas
What is the incidence of sarcoidosis?
High in north american black people
and northern european white
In black patients, women are more affected
people between 30-40 years old
What is the suspected etiology of sarcoidsis?
Unclear- but most likely caused by infectious or non-infectious environmental stimuli that triggers an inflammatory response in a genetically susceptible host.
What is the hallmark pathology of sarcoidosis?
noncaseating tissue granulomas are the hallmark
Explain what noncaseating granulomas are
Noncaseating= not necrotic
granulom= area of inflammation in tissue due to influx of granular leukocytes
they move into focal areas of tissues to due increased cytokine activity related to inflammation
What are the clinical findings of sarcoidosis?
Systematic symptoms are BROAD.
Lungs being 95%
Dry cough with dyspnea
fatigue
fever
night sweats
weight loss
What would you hear in the lungs of a sarcoidosis patient?
Crackles/rales on exam
What is lupus pernio?
blue-red or violaceous papules, nodules and plagues found on the nose, cheeks, ears and forehead
What skin changes would you see in a pt with sarcoidosis?
Lupus pernio
Erythema nodosum
Maculopapular trunk lesions
What is erythema nodosum?
non-specific, transient, painful, tender nodules of subcutaneous fat, classically pretibial. They appear infectious- but are sterile.
What are maculopapular trunk lesions?
Purplish/hyper-pigmented papules found on the torso. Painless and often overlooked. They are sporadic and can cover larges areas of the skin.
What are eye symptoms you’d suspect in a patient with sarcoidosis?
Dry eyes keratoconjunctivitis sicca
Anterior uveitis
Iritis
Retinitis
Can progress to blindness
What would you find in the lymph nodes of a sarcoidosis patient?
Granulomatous infiltration of lymph nodes, and enlargement anywhere on the body
What would you find in the liver of a sarcoidosis patient?
Granulomatous liver disease
Hepatomegaly
Hepatitis
Liver disease
What would happen to bone marrow and spleen if a patient has sarcodiosis?
Bone marrow suppression
anemia
leukopenia
splenomegaly due to granulomatous infiltration
increased blood cell sequestration causing worsening anemia and leukopenia
What is the calcium metabolism in a sarcoidosis patient?
Hypercalcemia
Granulomas produce 1,25 dihydroxyvitamin D which increases absorption of calcium causing hyper calcemia
Suppresses PTH levels
Is there a diagnosis test?
No, diagnosis is made based on hx, exam findings and laboratory findings
What would you find in a sarcoidosis pt’s chest x ray?
Bilateral hilar adenopathy
Increased size of mediastinal lymph nodes
Diffuse reticular infiltrates, nodles and potential cavitary lesions
What would you find a a sarcoidosis pt’s labs?
Leukopenia
Elevated ESR erythrocyte sedimentation rate
Hypercalcemia
Low PTH
What is the treatment for asymptomatic sarcoidosis?
The majority of asymptomatic patients do not require treatment.
What are the indications for treatment of a patient with sarcoidosis?
Presence of symptoms- dyspnea
Multisystem involve => 3
Increasing chest radiographic opacities
Extrapulmonary dicrease involving skin, bone, or joints
African descent due to lower chances of rapid recovery
What are the indications for treatment of a patient with sarcoidosis?
Presence of symptoms- dyspnea
Multisystem involve => 3
Increasing chest radiographic opacities
Extrapulmonary dicrease involving skin, bone, or joints
African descent due to lower chances of rapid recovery
What are the choices of treatment for patients who have indicators?
Oral corticosteroids
Long term prednisone followed by taper
must be given for 3-6 months to be effective and may last as long as 1 year.
They improve the chest x ray findings and symptoms but do not change the disease.
What is the 2nd line medication for sarcoidosis?
Immunosuppressive medication
Methotrexate, small trials show improvement
What is the prognosis of sarcoidosis?
The risk of death or organ dysfunction is low
2/3 patients may resolve their disease within 2-5 years
Minority develop chronic disease that lasts for decades
