Sarcoidosis

Question 1

Aetiology of sarcoidosis

Answer 1

generally genetic predisposition + exposure to antigen

Question 2

What does sarcoidosis cause the formation of and what do these cause?

Answer 2

non-caseating granulomas
organ damage and dysfunction

Question 3

What are the 3 presentations for sarcoidosis?

Answer 3

incidental finding - good prognosis

acute - flu-like illness, Lofgren’s syndrome, good prognosis

chronic - progressive symptoms (dyspnoea, cough), extra-pulmonary disease + organ dysfunction, may need long term treatment

Question 4

What is Lofgren’s syndrome?

Answer 4

bilateral hilar lymphadenopathy

erythema nodosum

arthralgia

Question 5

Sarcoidosis eyes manifestations

Answer 5

uveitis
lacrimal gland involvement
optic nerve involvement
glaucoma
granulomatous tissue within orbit

Question 6

Sarcoidosis respiratory tract manifestations

Answer 6

lymphadenopathy
ILD/scarring
airway obstruction + stenosis

Question 7

Sarcoidosis skin manifestations

Answer 7

erythema nodosum
subcutaneous nodules
lupus pernio

Question 8

Sarcoidosis MSK manifestations

Answer 8

myositis
arthralgia/arthritis
enthesitis

Question 9

Sarcoidosis eye symptoms

Answer 9

eye pain
visual disturbance
visual loss

Question 10

Sarcoidosis respiratory symptoms

Answer 10

exertional breathlessness
cough
wheeze

Question 11

Sarcoidosis neurological symptoms

Answer 11

seizures
headaches
cranial nerve palsies
mononeuritis multiplex

Question 12

Sarcoidosis cardiac symptoms

Answer 12

arrhythmia
ventricular failure
sudden cardiac death
exertional dyspnoea out of proportion to degree of respiratory disease

Question 13

Sarcoidosis abdominal symptoms

Answer 13

abdominal pain
haematuria
deranged LFTs
change in bowel habit
infertility

Question 14

Pulmonary sarcoidosis symptoms

Answer 14

lymphadenopathy (mediastinal + hilar) - bilateral + symmetrical

parenchymal disease - nodular disease, fibrosis

airway disease - asthma-like symptoms/bronchial hyper-reactivity, airway stenosis + occlusion

Question 15

Name 4 sarcoid ‘mimics’

Answer 15

chronic berylliosis
- clinically identical but clear beryllium exposure

granulomatous reactions to malignancy
- occurs in context of known malignancy

granulomatous-lymphocytic ILD (GLILD)
- occurs in setting of immune deficiency (CVID, CLL, HIV)

drug reactions
- anti-TNF monoclonal antibodies

Question 16

Investigations for sarcoidosis

Answer 16

Blood tests:
- FBC - lymphopenia, anaemia
- U&Es - renal dysfunction
- LFTs - derangement (obstructive or hepatitic)
- serum ACE - commonly elevated (not specific)
- Igs - associated with Ig deficiencies (esp. IgA)

Pulmonary function tests:
- any pattern - most commonly obstructive

CXR
CT chest
ECG (look for heart block)

Question 17

Does every sarcoidosis patient need treatment?

Answer 17

no
majority of patients will not need immediate treatment

Question 18

Describe Wells Law with regards to sarcoidosis treatment

Answer 18

2 reasons to initiate treatment in sarcoidosis:
- danger of damage to organs (including mortality)
- improve quality of life

Question 19

List some drugs that can be used in sarcoidosis treatment

Answer 19

prednisolone
methotrexate
azathioprine
mycophenolate mofetil
hydroxychloroquine
anti-TNF (infliximab, adalimumab)

Question 20

Prognosis of sarcoidosis

Answer 20

usually considered a benign condition
life expectancy not considered to be different to general population

Question 21

Which patients with sarcoidosis is mortality most common in?

Answer 21

patients with fibrosis, pulmonary hypertension and cardiac sarcoid