Sarcoidosis

Question 1

Sarcoidosis

Answer 1

Multisystem disorder of unknown aetiology

Non-caseating granulomas

More common in young adults and people of African descent

Women affected more

Question 2

Most commonly affected organ

Answer 2

Lungs

Question 3

Lung features

Answer 3

Mediastinal lymphadenopathy

Pulmonary fibrosis

Pulmonary nodules

Question 4

Systemic symptoms

Answer 4

Fever

Fatigue

Weight loss

Question 5

Liver features

Answer 5

Liver nodules

Cirrhosis

Cholestasis

Question 6

Eye features

Answer 6

Uveitis

Conjunctivitis

Optic neuritis

Question 7

Skin features

Answer 7

Erythema nodosum (tender red nodules on shins)

Lupus pernio (raised purple lesions on cheeks and nose)

Granulomas develop in scar tissue

Question 8

Heart features

Answer 8

Bundle branch block

Heart block

Myocardial muscle involvement

Question 9

Kidney features

Answer 9

Kidney stones (due to hypercalcaemia)

Nephrocalcinosis

Interstitial nephritis

Question 10

CNS features

Answer 10

Nodules

Pituitary involvement (diabetes insipidus)

Encephalopathy

Question 11

PNS features

Answer 11

Facial nerve palsy

Mononeuritis multiplex

Question 12

Bones

Answer 12

Arthralgia

Arthritis

Myopathy

Question 13

Lofgren’s syndrome

Answer 13

Triad of
- erythema nodosum
- bilateral hilar lymphadeonopathy
- polyarthralgia

Question 14

Factors associated with poor prognosis

Answer 14

Insidious onset (symptoms >6 months)

Absence of erythema nodosum

Extrapulmonary mainfestations

CXR: stage III-IV features

Question 15

Chest xray stages

Answer 15

0- normal

1- bilateral hilar lymphadenopathy

2- BHL and interstitial infiltrates

3- diffuse interstitial infiltrates only

4- diffuse fibrosis

Question 16

Other investigations

Answer 16

Spirometry: restrictive defect

Tissue biopsy: non-caseating granulomas

Question 17

Blood tests

Answer 17

Raised serum ACE (screening)

Hypercalcaemia is key finding

Raised serum soluble IL-2 receptor

Raised CRP

Raised immunoglobulins

Question 18

Histology

Answer 18

Gold standard for confirming diagnosis

Bronchoscopy with US guided biopsy of mediastinal lymph nodes

Shows non-caseating granulomas with epitheloid cells

Question 19

Treatment

Answer 19

No treatment in no/mild symptoms as condition often resolves spontaneously

Oral steroids 6-24 months (and bisphosphonates for bone protection)

Second line methotrexate or azathioprine

Lung transplant rarely required in severe disease

Question 20

Prognosis

Answer 20

Resolves within 6 months in 60% patients

Small number progress with pulmonary fibrosis and pulmonary hypertension (potentially requiring lung transplant)

Death usually when heart or CNS affected