Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

• Multisystem granulomatous disorder of unknown aetiology
• Pathologically characterised by presence of non-caseating granuloma in involved organs

Question 2

Describe the epidemiology of sarcoidosis.

Answer 2

• Affects any age - commoner in under 40s
• Affects males and females equally
• 0.5 to 1.3 per 100,000 in East Asia, 11.5 per 100,000 in Scandinavian countries and about 7 to 11 per 100,000 in the United States and Canada.

Question 3

What are granulomas characterised by?

Answer 3

• Aggregation of cells (mainly macrophages and lymphocytes) in response to inflammation

Question 4

What other possible conditions should be ruled out in order to diagnose sarcoidosis?

Answer 4

• Conditions also causing granulomatous inflammation e.g TB

Question 5

Sarcoidosis can become ‘involved’ in many different types of organs. What organ is most commonly involved in sarcoidosis?

Answer 5

LUNGS

Question 6

CLINICAL PRESENTATION - What symptoms would someone with pulmonary sarcoidosis present with?

Answer 6

• Dry cough and breathlessness
• Chest pain
• Fatigue, malaise, fever, weight loss
• Patients over 70 more likely to have systemic symptoms

Question 7

CLINICAL PRESENTATION - Upon examination, what signs would be indicative of pulmonary sarcoidosis?

Answer 7

• Digital clubbing (rare - usually associated to pulmonary fibrosis)
• Wheezing (when endobronchial involvement/traction bronchiectasis)
• Crackling not commonly heard (even when lung parenchymal sarcoidosis present)

Question 8

What investigations could be used to help diagnose sarcoidosis?

Answer 8

• CXR
• PFTs
• HRCT
• ECG – to look for conduction defects
• Serum ACE
• Basic biochemistry, FBC
• Tissue biopsy