Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

A multisystem granulomatous disorder (type 4 hypersensitivity). The antigen responsible is unknown.

Question 2

Which groups are most commonly diagnosed with sarcoidosis?

Answer 2

Often over 50 years old
Afro-Caribbean origin
Female gender

Question 3

What is the pathology in sarcoidosis?

Answer 3

Inhalation of an unknown antigen stimulates alveolar macrophages, CD4 cells, CD8 cells and B cells. However, these fail to clear the responsible antigen, thus there is persistent stimulation of the immune response, resulting in granuloma formation. The result is tissue damage and fibrosis.

Question 4

How does sarcoidosis present?

Answer 4

Bilateral hilar lymphadenopathy (on CXR)
Pulmonary infiltration (on CXR)
Erythema nodosum (rash on shins)
Asymptomatic (50% of cases)
Uveitis

Question 5

How will bloods be deranged in sarcoidosis?

Answer 5

Raised ACE levels, raised CRP, and hypercalcaemia.

Question 6

What form of granulomas are observed in sarcoidosis?

Answer 6

Non-caseating granulomas.

Question 7

How is acute sarcoidosis treated?

Answer 7

It may be self-limiting. Can give NSAIDs, and if vital organs are affected, give oral steroids.

Question 8

How is chronic sarcoidosis treated?

Answer 8

Give oral steroids - some may need immunosuppression (e.g. methotrexate).

Question 9

Should cases of sarcoidosis be monitored?

Answer 9

Yes, perform repeat CXR and PFT for multiple years as a relapsing/remitting pattern often observed.