Sarcoidosis

Question 1

what is sarcoidosis?

Answer 1

a non-caseating granulomatous (type 4 hypersensitivity) disease of unknown cause

Question 2

The cause is unknown but what might be involved?

Answer 2

• an ineffective agent in a susceptible individual.

- imbalance of immune system with type 4 hypersensitivity

Question 3

who is it less and more common in?

Answer 3

• less common in smokers

- more common in afro-caribbean populations

Question 4

there is multisystem involvement which are the common and uncommon sites of involvement?

Answer 4

common: lungs, lymph nodes, joints, liver, skin, eyes
uncommon: kidneys, brain, permanent damage

Question 5

what are the symptoms for acute sarcoidosis?

Answer 5

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

Question 6

what are the symptoms and characteristics of chronic lymphadenopathy

Answer 6

• lung infiltrates (alveolitis)
• skin infiltrations
• peripheral lymphadenopathy
• hypercalcaemia
• can get end-organ damage such as renal, myocardial, neurological, hepatitis, splenomegaly

Question 7

what should be on the differential diagnosis

Answer 7

• TB (tuberculin skin test negative)
• lymphoma
• carcinoma
• fungal infection

Question 8

what investigations should be done to lead to a diagnosis?

Answer 8

• CXR
• CT
• tissue biopsy
• blood test

Question 9

what would the CXR show?

Answer 9

bilateral hilar lymphadenopathy, nodules along fissures

Question 10

what would a CT show maybe?

Answer 10

peripheral nodular infiltrate

Question 11

tissue biopsy ?

Answer 11

(e.g. transbronchial, skin, lymph node)

non-caseating granuloma

Question 12

what would the blood tests show?

Answer 12

• raised calcium
• increased inflammatory markers
• renal function

Question 13

what are the severity marker investigations ?

Answer 13

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

Question 14

What is the treatment for acute sarcoidosis

Answer 14

it is a self limiting condition so usually no treatment is administered-but treat the other multisystem involvement

Question 15

what is given in acute S if a vital organ is affected?

Answer 15

steroids

Question 16

which problem needs steroid treatment and why?

Answer 16

uveitis: because patients can end up with permanent damage

Question 17

what is the treatment for chronic sarcoidosis ?

Answer 17

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

Question 18

what steroid sparing drugs are given? and what do they do?

Answer 18

immunosuppressants (e.g. azathioprine, methotrexate, anti-TNF therapy)

switches off sarcoidosis effectively