Sarcoidosis Flashcards
Sarcoidosis
What is it?
a chronic multisystemic disorder of unknown aetiology, characterised by the presence of non-caseating granulomas, most commonly affecting the lungs, skin and eyes
Sarcoidosis
What demographic of pt tend to be diagnosed with it?
- women
- 30s-40s
Sarcoidosis
Sarcoidosis can affect any organ in the body, but most commonly affects ____ and as such with the following symptoms:
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- lungs
- cough, wheeze, exertational dyspnoea
Sarcoidosis
Constitutional symptoms are also common and include ____.
3
fever, weight loss and chronic fatigue
Sarcoidosis
Other clinical features of sarcoidosis are listed below:
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- Hepatomegaly
- Splenomegaly
- Lymphadenopathy
- Ocular involvement – anterior uveitis or keratoconjunctivitis sicca
- Hypercalcaemia and nephrocalcinosis
- Erythema nodosum
- Neurological symptoms – seizures, cranial nerve palsies and peripheral neuropathy
- Cardiac arrhythmias
Sarcoidosis
What is Löfgren syndrome?
acute onset of erythema nodosum, bilateral hilar lymphadenopathy, fever and arthralgia
It is a common classic syndrome of sarcoidosis
Sarcoidosis
What is the name of the sydrome with these manifestiations?
acute onset of erythema nodosum, bilateral hilar lymphadenopathy, fever and arthralgia
Löfgren syndrome
Sarcoidosis
What specific combination of symptoms is very suggestive of sarcoidosis and often requires no further investigation?
Löfgren syndrome:
acute onset of erythema nodosum, bilateral hilar lymphadenopathy, fever and arthralgia
Sarcoidosis
Initial tests to perform in people with suspected sarcoidosis include:
- FBC – often shows leukopenia and anaemia
- Serum Ca2+ – may be elevated
- Serum ACE – elevated, this is a non-specific marker of disease activity and can be used to monitor the clinical course
- CXR– the initial modality for staging sarcoidosis, showing bilateral hilar lymphadenopathy, pulmonary infiltrates or fibrosis.
Sarcoidosis
elevated, what is a non-specific (blood test) marker of disease activity and can be used to monitor the clinical course
serum ACE
Sarcoidosis
If the lung fields appear normal on plain x-ray and bronchoscopy what scan may be done?
HRCT
Sarcoidosis
A HRCT scan will often reveal what?
reticulonodular opacities with a perilymphatic distribution, classically in the upper lobes of the lungs
Sarcoidosis
Bronchoscopy can be used to visualise the ____, as well as to take ____ (to assess for granulomas) and sample bronchoalveolar lavage fluid (typically showing an increased____).
Bronchoscopy can be used to visualise the mucosa, as well as to take transbronchial biopsies (to assess for granulomas) and sample bronchoalveolar lavage fluid (typically showing an increased CD4:CD8 T cell ratio).
Sarcoidosis
How do we manage pt with pulmonary symptoms? (prescribing)
corticosteroids
- oral prednisolone or inhaled budesonide.
- Corticosteroids are also indicated for dermatological, ocular and nervous system involvement.
Alternative immunosuppressants
- methotrexate, hydroxychloroquine or azathioprine.
Sarcoidosis
At what stage of disease would a trasplant be indicated?
End-stage lung disease (stage IV sarcoidosis and respiratory failure)
Sarcoidosis is the second most common indication of lung transplant for interstitial lung disease.
