Sarcoidosis Flashcards
what is sarcoidosis?
a non-caseating granulomatous (type 4 hypersensitivity) disease of unknown cause
The cause is unknown but what might be involved?
- an ineffective agent in a susceptible individual.
- imbalance of immune system with type 4 hypersensitivity
who is it less and more common in?
- less common in smokers
- more common in afro-caribbean populations
there is multisystem involvement which are the common and uncommon sites of involvement?
common: lungs, lymph nodes, joints, liver, skin, eyes
uncommon: kidneys, brain, permanent damage
what are the symptoms for acute sarcoidosis?
over the course of a week or two you will start to feel generally unwell and will often develop erythema nodosum
- sweats
- erythema nodosum
- bilateral hilar lymphadenopathy
- arthritis
- uveitis
- parotitis (inflammation of the salivary glands)
- fever
what are the symptoms and characteristics of chronic lymphadenopathy
- lung infiltrates (alveolitis)
- skin infiltrations
- peripheral lymphadenopathy
- hypercalcaemia
- can get end-organ damage such as renal, myocardial, neurological, hepatitis, splenomegaly
what should be on the differential diagnosis
- TB (tuberculin skin test negative)
- lymphoma
- carcinoma
- fungal infection
what investigations should be done to lead to a diagnosis?
- CXR
- CT
- tissue biopsy
- blood test
what would the CXR show?
bilateral hilar lymphadenopathy, nodules along fissures
what would a CT show maybe?
peripheral nodular infiltrate
tissue biopsy ?
(e.g. transbronchial, skin, lymph node)
non-caseating granuloma
what would the blood tests show?
- raised calcium
- increased inflammatory markers
- renal function
what are the severity marker investigations ?
ANGIOTENSIN CONVERTING ENZYME: act as an activity marker. This is NOT a diagnostic marker as it is quite non-specific
PULMONARY FUNCTION: restrictive defect due to lung infiltrations.
- this is really to see how affected the patient is by the disease
What is the treatment for acute sarcoidosis
it is a self limiting condition so usually no treatment is administered-but treat the other multisystem involvement
what is given in acute S if a vital organ is affected?
steroids
which problem needs steroid treatment and why?
uveitis: because patients can end up with permanent damage
what is the treatment for chronic sarcoidosis ?
This does need treatment oral steroids if vital organ is affected (e.g. lungs, eyes, heart, brain)
they are given prednisolone or steroid sparing drugs
what steroid sparing drugs are given? and what do they do?
immunosuppressants (e.g. azathioprine, methotrexate, anti-TNF therapy)
switches off sarcoidosis effectively
