Sarcoidosis

Question 1

Sarcoidosis =

Answer 1

multisystem inflammatory granulamatous disease of unknown etiology
Commonly effects young and middle-aged adults

Question 2

Initial presentation

Answer 2

Commonly presents initially with on of these abnormalities:
Bilateral hilar adenopathy
Pulmonary reticular opacities
Skin, joint, and/or eye lesions

Question 3

Epidemiology

Answer 3

3-4 x more likely in blacks

Question 4

Symptoms

Answer 4

Cough 
Dyspnea
Chest Pain
Eye and skin lesions
Fatigue 
Malaise
Fever 
Wt loss
Systemic inflammation: Musc weakness, exercise intolerance

Question 5

Labs

Answer 5

CBC c diff (leukopenia)
CMP (hypercalciuria is more common than hypercalcemia)
UA
Phos
ERS - elevated
Serum gamma globulin
Serum angiotensin-converting enzyme - elevated

Question 6

Staging

Answer 6

Stage I - Bilateral hilar adenopathy, often accompanied by Rt paratracheal node enlargement

Stage II - Bilateral hilar adenopathy and reticular opacities

Stage III - reticular opacities with shrinking hilar nodes

Stage IV - reticular opacities with evidence of volume loss, predominantly distributed in upper lung zones, conglomerated masses with marked traction bronchiectasis may also be seen, Extensive calcification and cavitation may also be seen

Question 7

Chest CT

Answer 7

Can show:
hilar and mediastinal lymphadenopathy
Bronchial wall thickening
Ground glass opacification
Parynchemal masses or consolidation
cysts
Traction bronchiectasis
Fibrosis with distortion of lung architecture

Question 8

PET scan

Answer 8

may be helpful to ID occult lesions and possibly reversible granulatomous disease

Question 9

Lung bx

Answer 9

Usually necessary for dx and pt will require referral to pulm specialist
Although bx not required to make dx, it should be performed.

Question 10

Occular lesions

Answer 10

seen in 20% of cases

present with redness, photophobia, decreased visual acutiy

Question 11

Skin lesions

Answer 11

20-30% of cases

present with maculopapular rash over face and hairline, erythema nodosum

Question 12

PE

Answer 12

Unusual to detect adventitious lung sounds

Occasionally wheezing may be audible

Question 13

DD

Answer 13

Hypersensitivity PNA
Asbestosis
Silicosis
Infection, inculding: TB, histoplasmosis, atypical mycobacterial infections
Malignancy: lymphoma
Drug effects
Vasculitis: Wegener's granulomatosis

Question 14

Tx

Answer 14

No standardized indications for tx
No tx recommended for asymptomatic pt’s co stage I or II
May use: NSAIDs for fever or joint pain, prednisone low dose 15-20mg/day if no response to NSAIDs, inhaled corticosteroids
Methotrexate, Cyclophosphomide, Azathoprine

Question 15

Pt edu

Answer 15

d/t nature of dz, varied presentation and side effects must be explained
Meds and side effects
signs of recurrence of sarcoidosis