Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

Abnormal collections of granulomas that can form in multiple organs

Granulomas are NON-caseating, unlike TB

Question 2

What is the cause of sarcoidosis?

What are the risk factors?

Answer 2

Cause is unknown!

• Young northern or afrocaribean women
• HLA-DRB1 & DQB1 associations

Question 3

What are the clinical features of sarcoidosis?

Answer 3

A SARCOID

• Asymptomatic (20-40%)
• Skin - erythema nodosum
• Arthritis - polyarthralgia
• Respiratory
  
  • CXR - bilat. hilar lymphadenopathy +/- infiltrates/ fibrosis/ bulla
  • Dry cough, dyspnoea, chest pain
• Cardiac - heart block, VT, HF
• Occular - uveitis
• Intracranial - meningitis, seizures, neuropathy
• Derangement of liver/ renal function

Question 4

What are the tests for sarcoidosis?

Answer 4

• Tissue biopsy
  
  • ​Diagnostic & shows non-caseating granulomata
• CXR (abnormal 90%!), stages;
  
  1. Normal
  2. Bilateral hilar lymphadenopathy
  3. BHL + peripheral pulmonary infiltrates
  4. Peripheral pulmonary infiltrates alone
  5. Progressive pulmonary fibrosis, bulla formation (honeycombing), pleural involvement
• CT/ MRI to assess severity
• Tuberculin skin test; -ve in 2/3
• 24hr urine; Inc Ca2+
• Bloods
  
  • Inc ESR, LFT, serum ACE, Ca2+, immunoglobulins
  • Lymphopenia
• Lung function tests;
  
  • Normal
  • Reduced volumes, impaired gas transfer, restrictive ventilatory defect
• Bronchoalveolar lavage (BAL); Inc lymphocytes & neutrophils & pulmonary fibrosis
• ECG; arrythmias, BBB
• USS; nephrocalcinosis, hepatosplenomegaly
• Bone XR; punched out lesions in terminal phalanges

Question 5

What is the management of sarcoidosis?

Answer 5

Acute sarcoidosis; bed rest & NSAIDs

Indications for corticosteroids (prednisolone);

• Parenchymal lung disease
• Uveitis
• Hypercalcaemia
• Neurological/ cardiac involvement