Sarcoidosis

Question 2

Sarcoidosis: What is it?

Answer 2

Sarcoidosis= achronic granulomatous disorder.Granulomasareinflammatorynodulesfull ofmacrophages. Has pulmonary and extrapulmonary manifestations.

Question 3

Sarcoidosis: Epidemiology

Answer 3

• Aged 20-39 or around 60
• Women
• Black ethnic origin

Question 4

Sarcoidosis: Symptoms

Answer 4

The symptoms that present depend on the organs affected:
Systemic Symptoms:
- Fever
- Fatigue
- Weight loss
Lungs:
- Mediastinal lymphadenopathy
- Pulmonary fibrosis
- Pulmonary nodules
Heart:
- Bundle branch block
- Heart block
- Myocardial muscle involvement
Bones:
- Arthralgia
- Arthritis
- Myopathy
Eyes:
- Uveitis
- Conjunctivitis
- Optic neuritis
Kidneys:
- Kidney stones (due to hypercalcaemia)
- Nephrocalcinosis
- Interstitial nephritis
Central nervous system:
- Nodules
- Pituitary involvement (diabetes insipidus)
- Encephalopathy
Peripheral Nervous System:
- Facial nerve palsy
- Mononeuritis multiplex
Skin:
- Erythema nodosum – raised, red, and painful nodules ofinflamedsubcutaneous faton the shins. Inflammation of fat is calledpanniculitis. Over time the nodules settle and appear as bruises. Not specific to sarcoidosis as there are many other causes of erythema nodosum.
- Lupus pernio– raised purple skin lesions, often on the cheeks and nose.

Question 5

Sarcoidosis: Physical Examination

Answer 5

N/A

Question 6

Sarcoidosis: Investigations

Answer 6

• bmi
• blood tests:
• The blood test findings to remember are:
• Raisedangiotensin-converting enzyme(ACE) (often used as a screening test)
• Raisedcalcium(hypercalcaemia)
• fbc
• U&Esfor kidney involvement
• Urine albumin-creatinine ratioto look forproteinuria
• LFTsfor liver involvement
• Ophthalmologyassessment for eye involvement
• ECGandechocardiogramfor heart involvement
• Ultrasoundfor liver and kidney involvement
• lung biopsy for histology – shows showsnon-caseating granulomaswithepithelioid cells.
• • Chest x-raymay showhilar lymphadenopathy
• High-resolution CTscanning**may showhilar lymphadenopathyandpulmonary nodules
• MRIcan showcentral nervous system involvement
• PET scancan show active inflammation in affected areas

Question 7

Sarcoidosis: Management

Answer 7

Conservative managementis considered in patients with no or mild symptoms.

Oral steroids(for 6-24 months) are usually first-line where treatment is required.Bisphosphonatesprotect against osteoporosis whilst on long-term steroids.

Methotrexateis a second-line option.

Lung transplantis rarely required in severe pulmonary disease.

Sarcoidosis spontaneously resolves in around half of patients, usually within two years.

Question 8

Sarcoidosis: Complications

Answer 8

• pulmonary fibrosis
• pulmonary hypertension.

Question 9

Sarcoidosis: Differential Diagnosis

Answer 9

The top differentials for the varied presenting features of sarcoidosis are:
- Tuberculosis
- Lymphoma
- Hypersensitivity pneumonitis
- HIV
- Toxoplasmosis
- Histoplasmosis