Sarcoidosis

Question 1

What is Sarcoidosis and it’s most common epidemiology?

Answer 1

Chronic granulomatous disorder

Black women aged 20-39 or around 60

Teh granulomas are inflammatory nodules full of macrophages

Question 2

20-40 year old black female presnets with a dry cough and shortness of breath, with nodules on their shins. Diagnosis?

Answer 2

Sarcoidosis

Question 3

Skin features suggesting sarcoidosis?

Answer 3

Erythema nodosum- nodules of inflamed subcutaneous fat on the shins- red, painful, raised and tender

Lupus pernio- presents with raised purple skin lesions often on the cheeks and nose

Lupus pernio- is specific to sarcoidosis

Question 4

Symtoms of sarcoidosis?

Answer 4

• Respiratory- shortness of breath and dry cough
• Fever
• Fatigue
• Weightloss
• Liver cirrhosis
• Eyes- Uveitis, Conjunctivitis, optic neuritis

Uveitis- painful inflammation of eye (looks red)- effects vision

Question 5

Lofgren’s syndrome triad of symptoms?

Answer 5

1. Erythema nodosum
2. Bilateral hilar lymphadenopathy (enlargement of lymph npdes of pulmonary hilar)
3. Polyarthralgia (joint pain in multiple joints)

Also have fever

Specific presentation of sarcoidosis

Question 6

Differnetial diagnoses for Sarcoidosis? (4)

Answer 6

• Tuberculosis
• HIV
• Lymphoma
• Hypersensitivity pneumonitis

Question 7

Blood test findings for sarcoidosis? (2)

Answer 7

**Raised **angiotensin-converting enzyme (ACE)- often used as a screening test

Raised calcium (hypercalcaemia)

Question 8

4 stages of sarcoidosis?

Answer 8

Stage 1- Hilar lymphadenopathy only
Stage 2- Hilar lymphadenopathy and parenchymal involvement
Stage 3- Parenchymal involvement only
Stage 4- Pulmonary fibrosis

Stage 3+ 4 are liekly to progress and need treatment

Question 9

A patient is complaining of eye problems e.g. uveitis. What investigation could be done?

Answer 9

Slit-lamp examination

Reffered to opthalmology- risk of retinal detachment and other eye complications

Question 10

Heerfordt’s syndrome triad of symptoms?

Answer 10

Acute uveitis
Fever
Parotid gland swelling

Rare acute presentation of neurosarcoidosis- some patients also have facial pasy

Question 11

4 stages of sarcoidosis?

Answer 11

1. Hilar lymphadenopathy only
2. Hilar lymphadenopathy and parenchymal involvement
3. Parenchymal involvement only
4. Pulmonary fibrosis

Question 12

Indications for steroid use in sarcoidosis?

Answer 12

• Hypercalcaemia
• Eye or neuro involvement
• Patients with chest x-ray stage 2 or 3 disease