Sarcoidosis

Question 1

What is a granuloma?

Answer 1

A small, noncancerous cluster of immune cells (macrophages) that forms in response to chronic inflammation or infection.

Question 2

What is sarcoidosis?

Answer 2

A systemic granulomatous disease characterised by the formation of non-caseating granulomas, which can affect any organ.

Question 3

What are the 2 most commonly involved sites in saroidosis?

Answer 3

1) lungs
2) intrathoracic lymph nodes

Question 4

Pathophysiology of sarcoidosis?

Answer 4

Characterised by an exaggerated immune response, leading to the formation of non-caseating granuloma

Question 5

What 2 clinical syndromes are associated with sarcoidosis?

Answer 5

1) Lofgren’s syndrome

2) Heerfordt’s syndrome

Question 6

What is Lofgren’s syndrome?

Answer 6

An acute form of the disease (sarcoidosis).

It usually carries an excellent prognosis

Question 7

What 4 features are seen in Lofgren’s syndrome?

Answer 7

1) bilateral hilar lymphadenopathy (BHL)

2) erythema nodosum

3) fever

4) polyarthralgia

Question 8

What features are seen in Heerfordt’s syndrome (uveoparotid fever)? (3)

Answer 8

1) parotid enlargement

2) fever

3) uveitis

all 2ary to sarcoidosis

Question 9

Clinical features of sarcoidosis?

Answer 9

1) Common:
- cough
- SOB
- chest pain
- fever, fatigue & weight loss

2) Löfgren’s syndrome

3) Uveitis

4) Peripheral neuropathy

5) Cardiac arrhythmias

6) Skin manifestations e.g. erythema nodosum

Question 10

What bloods are indicated in sarcoidosis?

Answer 10

1) FBC

2) Serum & urine calcium

3) LFTs

4) Serum ACE

5) Serum and urine electrophoresis

Question 11

What may FBC show in sarcoidosis?

Answer 11

May demonstrate anaemia, leucopenia, or thrombocytopenia, although non-specific.

Question 12

Role of serum & urine calcium test in sarcoidosis?

Answer 12

Hypercalcaemia & hypercalciuria can occur due to increased vitamin D activation by macrophages in sarcoidosis.

Question 13

What can cause hypercalcaemia & hypercalciuria in sarcoidosis?

Answer 13

increased vitamin D activation by macrophages in sarcoidosis.

Question 14

What may LFTs show in sarcoidosis?

Answer 14

Elevated ALP might suggest liver involvement

Question 15

Serum ACE levels in sarcoidosis?

Answer 15

Raised

Question 16

Role of serum and urine electrophoresis in sarcoidosis?

Answer 16

To exclude other granulomatous disorders e.g. multiple myeloma.

Question 17

What pulmonary investigations may be indicated in sarcdoidosis?

Answer 17

1) CXR (1st line)

2) HRCT

3) Pulmonary function tests

4) Bronchoscopy with transbronchial lung biopsy

Question 18

What can CXR shoe in sarcoidosis?

Answer 18

Bilateral hilar lymphadenopathy

Question 19

What may pulmonary function tests show in sarcoidosis?

Answer 19

Restrictive pattern with reduced lung volumes and impaired gas transfer.

Question 20

Bronchoscopy with transbronchial lung biopsy is a key investigation for obtaining tissue diagnosis.

What is a typical finding?

Answer 20

Non-caseating granulomas

Question 21

Biopsy of the affected organ or tissue (e.g., skin, lymph node) is pivotal for a definitive diagnosis of sarcoidosis (gold standard).

Histologically, what is the hallmark of sarcoidosis?

Answer 21

Non-caseating granulomas

Question 22

What is the gold standard investigation for diagnosis of sarcoidosis?

Answer 22

Tissue biopsy showing non-caseating granulomas

Question 23

What does mx of sarcoidosis depend on?

Answer 23

Depends on the severity and extent of organ involvement.

Asymptomatic patients or those with mild disease may not require treatment, as spontaneous remission is common.

Question 24

1st line xx of sarcoidosis in patients w/ symptomatic or progressive disease?

Answer 24

1st line –> systemic corticosteroids e.g. prednisolone 20-40mg daily

Question 25

What are some factors associated with a poor prognosis in sarcoidosis?

Answer 25

1) insidious onset, symptoms > 6 months

2) an absence of erythema nodosum

3) extrapulmonary manifestations: e.g. lupus pernio, splenomegaly

4) CXR: stage III-IV features

5) people of Black African ethnicity

Question 26

Cause of elevated calcium and low PTH in sarcoid?

Answer 26

The elevated calcium and low PTH hormone can occur due to increased production of 1,25-dihydroxyvitamin D by activated macrophages in
the granulomas.