Sarcoidosis

Question 1

Definition of sarcoidosis

Answer 1

A chronic granulomatous disorder or unknown aetiology, commonly affecting the lungs, eyes and skin

Question 2

Aetiology of sarcoidosis:

Answer 2

Unknown aetiology, but factors such as genetics, immunological and infectious causes have been considered

Question 3

Risk factors for sarcoidosis

Answer 3

• Age 20-40
• Family history

Question 4

Pathophysiology of sarcoidosis

Answer 4

• Characteristic finding is the presence of NON-caseating granulomas with multinucleated giant cells in the centre
• Occurs due to accumulation of lymphocytes and macrophages
• Can have multi-system manifestations

Question 5

History and Examination of sarcoidosis

Answer 5

• Cough: non-productive
• Dyspnoea: gradual onset that can then worsen
• Chronic fatigue
• Arthralgia: pain in knees, ankles and/or wrists
• Wheezing or rhonchi
• Lymphadenopathy: may have enlarged lymph nodes
• Red painful eye, blurred vision: can be symptoms of uveitis, conjunctivitis etc
• Erythema nodosum

Question 6

Investigations for sarcoidosis

Answer 6

• Chest X Ray: most patients would have bilateral hilar lymphadenopathy +- pulmonary infiltrates
Serum ACE: would be raised
Urea and creatinine may be raised if kidney is involved
Hypercalcaemia

Question 7

Treatment of sarcoidosis

Answer 7

Low stage without adenopathy (node swelling):
1) Observation

Higher stage with symptoms or adenopathy:
1) Oral or inhaled corticosteroids: oral are preferred (prednisolone)

Question 8

Prevention and prognosis of sarcoidosis

Answer 8

Annual influenza and pneumococcal vaccine recommended for secondary prevention

Most recover, but remission can occur

Question 9

Complications of sarcoidosis

Answer 9

• Meningitis
• Uveitis
• Conjunctivitis
• Erythema nodosum
• Hypercalcaemia
• Arrhythmias