Sarcoidosis

Question 1

What is sarcoidosis

Answer 1

1. Systemic, granulomatous disease of unknown etiology
   *can involve many systems
   *non-caseating granulomas (lung involvement (90%))
   *bilatera hilar lymphadenopathy (75-90%)

Question 2

What are the demographics of sarcoidosis

Answer 2

1. Higher incidence in North American African Americans and Northern European caucasians
   *no genetic predisposition known
2. Onset 30 to 40 years old
3. Autoimmune, rheumatologist disease state

Question 3

What is the pathology behind sarcoidosis (1)

Answer 3

1. Exaggerated T lymphocyte response to exogenous or autologous antigens
2. Cells accumulate in the affected organs, secrete lymphokines and recruit macrophages
3. T cell accumulation results in formation of non-caseating granulomas

Question 4

What is the pathology behind sarcoidosis (2)

Answer 4

1. Multiple granulomas are scattered through the intersitiutm of the lung
2. Granulomas take up space that disrupts the normal/healthy structure/function of the tissues that they from in

Question 5

What accounts for the high diagnostic yield on bronchoscopes biopsy

Answer 5

1. Frequent bronchial or bronchioar submucosal infiltration by sarcoid granulomas
   *cellular granulomatous phase of sarcoidosis can further progress to fibrotic phase

Question 6

What are the signs and symptoms of sarcoidosis

Answer 6

Asymptomatic (50%) incidental findings on CXR
1. Pulmonary
*dyspnea
*cough
2. Insidious onset
3. Skin manifestations
*erythema nodosum
*lupus pernio

Question 7

What are other manifestations of sarcoidosis

Answer 7

1. Fever
2. Malaise
3. Uveitis
4. Iritis
5. Conjunctivitis
6. Glaucoma

Question 8

What are the MS signs of sarcoidosis

Answer 8

1. Myopathies
2. Myositis
3. Polyarhritis (ankles, knees, wrists)

Question 9

What are the neurological signs of sarcoidosis

Answer 9

1. CN palsies
2. Meningitis
3. Neuroendocrine dysfunction
4. Neuropathy

Question 10

What are the cardiac signs of sarcoidosis

Answer 10

1. Chest pain
2. Arrhythmia
3. Conduction delays
4. Pulmonary HTN
5. CHF
6. Pericarditis

Question 11

What are the liver signs of sarcoidosis

Answer 11

1. Abdominal pain
2. Jaundice
3. Varices
4. Granulomatous hepatitis

Question 12

What are the endocrine signs of sarcoidosis

Answer 12

1. Hypercalcemia
2. Goiter
3. Thyroid nodules

Question 13

What will be on the PE

Answer 13

1. Atypical of ILD
   *no crackles
2. Parotid gland enlargement
3. Hepatosplenomegaly
4. Lymphadenopathy
5. Signs from the previous slides

Question 14

What is the DDx

Answer 14

1. Amyloidosis
2. Lymphoma
3. Fungal infection
4. Tuberculosis

Question 15

What diagnostic tests to complete

Answer 15

1. ACE levels
   *elevated (40 to 80% of patients)
2. PFT (restrictive)
3. Ophthalmic examination
4. Chest radiography
5. CBC, ESR, CMP, UA, EKG

Question 16

What can the diagnosis be confirmed with

Answer 16

1. Histological demonstration of granulomas
   *biopsy will show
   *demonstration of non-caseating granulomas
   *BAL does not establish diagnosis

Question 17

What are the pulmonologic treatment of sarcoidosis

Answer 17

1. Steroids
2. Lung transplant

Question 18

What are the arthralgias treatment of sarcoidosis

Answer 18

1. Steroids
2. NSAIDs
3. Colchicine
4. Biologics
5. Steroid sparing agents

Question 19

What are the immunosuppressive treatment of sarcoidosis

Answer 19

1. Methotrexate
2. Azathioprine
3. Infliximab

Question 20

What is the prognosis of sarcoidosis

Answer 20

1. Best for hilar adenopathy involvement alone (stage I)
   *pulmonary involvement have irreversible complications
2. Long term follow-up, annual check up