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 feature is associated with sarcoidosis?
Uveitis.
What skin feature 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This term is now considered outdated and unhelpful by many as there is a confusing overlap with Sjögren’s syndrome.
What is Heerfordt’s syndrome?
Heerfordt’s syndrome (uveoparotid fever) features parotid enlargement, fever, and uveitis secondary to sarcoidosis.
Is there a definitive diagnostic test for sarcoidosis?
No, diagnosis is largely clinical.
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?
They may have a role in monitoring disease activity.
What routine blood findings may indicate sarcoidosis?
Hypercalcaemia (seen in 10% of patients) and a raised ESR.
What does a chest x-ray show in stage 0 of sarcoidosis?
Normal.
What does a chest x-ray show in stage 1 of sarcoidosis?
Bilateral hilar lymphadenopathy (BHL).
What does a chest x-ray show in stage 2 of sarcoidosis?
BHL + interstitial infiltrates.
What does a chest x-ray show in stage 3 of sarcoidosis?
Diffuse interstitial infiltrates only.
What does a chest x-ray show in stage 4 of sarcoidosis?
Diffuse fibrosis.
What may spirometry show in sarcoidosis?
A restrictive defect.
What does a tissue biopsy reveal in sarcoidosis?
Non-caseating granulomas.
Is the gallium-67 scan used routinely in sarcoidosis?
No, it is not used routinely.
What is the Kveim test?
It involved injecting part of the spleen from a patient with known sarcoidosis under the skin, but 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 for sarcoidosis?
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 disease 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 prognosis for sarcoidosis without treatment?
Sarcoidosis remits without treatment in approximately two-thirds of people.
What are factors 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
