Sarcoidosis Flashcards
What is sarcoidosis?
Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is more common in young adults and in people of African descent.
What are the acute features of sarcoidosis?
Acute features include erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, and polyarthralgia.
What are the insidious features of sarcoidosis?
Insidious features include dyspnoea, non-productive cough, malaise, and weight loss.
What ocular condition is associated with sarcoidosis?
Uveitis.
What skin condition is associated with sarcoidosis?
Lupus pernio.
What causes hypercalcaemia in sarcoidosis?
Macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol).
What is Lofgren’s syndrome?
Lofgren’s syndrome is an acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever, and polyarthralgia. It usually carries an excellent prognosis.
What is Mikulicz syndrome?
Mikulicz syndrome involves enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis, or lymphoma.
This term is now considered outdated and unhelpful by many as there is a confusing overlap with Sjogren’s syndrome.
What is Heerfordt’s syndrome?
Heerfordt’s syndrome (uveoparotid fever) involves parotid enlargement, fever, and uveitis secondary to sarcoidosis.
What is the diagnostic approach for sarcoidosis?
Diagnosis is largely clinical as there is no one diagnostic test for sarcoidosis.
What are the sensitivity and specificity of ACE levels in diagnosing sarcoidosis?
ACE levels have a sensitivity of 60% and specificity of 70%.
What role do ACE levels play in sarcoidosis?
ACE levels are not reliable for diagnosis but may help in monitoring disease activity.
What routine blood findings may be present in sarcoidosis?
Routine bloods may show hypercalcaemia in 10% of patients and a raised ESR.
What does a chest x-ray show in stage 0 of sarcoidosis?
Stage 0 = normal.
What does a chest x-ray show in stage 1 of sarcoidosis?
Stage 1 = bilateral hilar lymphadenopathy (BHL).
What does a chest x-ray show in stage 2 of sarcoidosis?
Stage 2 = BHL + interstitial infiltrates.
What does a chest x-ray show in stage 3 of sarcoidosis?
Stage 3 = diffuse interstitial infiltrates only.
What does a chest x-ray show in stage 4 of sarcoidosis?
Stage 4 = diffuse fibrosis.
What might spirometry show in sarcoidosis?
Spirometry may show a restrictive defect.
What does a tissue biopsy reveal in sarcoidosis?
Tissue biopsy shows non-caseating granulomas.
Is the gallium-67 scan used routinely in sarcoidosis?
No, the gallium-67 scan is not used routinely.
What is the Kveim test and its current status?
The Kveim test involves injecting part of the spleen from a patient with known sarcoidosis under the skin, but it is no longer performed due to concerns about cross-infection.
What is sarcoidosis?
Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas.
Who is more commonly affected by sarcoidosis?
It is more common in young adults and in people of African descent.
When are steroids indicated in sarcoidosis management?
Steroids are indicated for patients with chest x-ray stage 2 or 3 disease who are symptomatic.
Do asymptomatic patients with stable stage 2 or 3 sarcoidosis require treatment?
No, asymptomatic and stable stage 2 or 3 disease patients with only mildly abnormal lung function do not require treatment.
What are other indications for steroids in sarcoidosis?
Indications include hypercalcaemia and eye, heart, or neuro involvement.
What is sarcoidosis?
Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas.
Who is more commonly affected by sarcoidosis?
It is more common in young adults and in people of African descent.
What is the typical prognosis for sarcoidosis without treatment?
Sarcoidosis remits without treatment in approximately two-thirds of people.
What factors are associated with poor prognosis in sarcoidosis?
- Insidious onset, symptoms > 6 months
- Absence of erythema nodosum
- Extrapulmonary manifestations: e.g. lupus pernio, splenomegaly
- CXR: stage III-IV features
- Black African or African-Caribbean ethnicity
