Sarcoidosis

Question 1

What is sarcoidosis

Answer 1

A multi-system disorder characterized histologically by non-caseating granulomas

Question 2

Who is most likely to get sarcoidosis

Answer 2

Women aged 20-40, particularly Afro-Caribbean/African-American

Question 3

How might a patient with sarcoidosis present

Answer 3

Breathlessness
Chest pain
Malaise
Dry cough
Low grade pyrexia

Question 4

What would you expect to see on CXR of a patient with sarcoidosis

Answer 4

Bilateral hilar lymphadenopathy/pulmonary infiltrates

Fibrosis in severe cases

Question 5

What non-pulmonary manifestations of sarcoidosis are there

Answer 5

Skin - erythema nodosum, lupus pernio
Eyes - posterior or anterior uveitis/conjunctivitis/episcleritis, keratoconjunctivitis sicca
Heart - Cardiomyopathy, arrhythmia
Joints - arthralgia
Metabolic - hypercalcaemia (can cause renal calculi)
Neuro - cranial nerve palsies, meningitis
Other - lymphadenopathy, hepatosplenomegaly, enlargement of the parotid glands

Question 6

What specific blood test might you do to help diagnose sarcoidosis

Answer 6

Serum ACE - raised in 60% patients

Question 7

How do you manage sarcoidosis

Answer 7

Oral steroid therapy (at least 12 mths), particularly for - eye/cardiac/neuro involvement or if resp symptoms persist

Around 50% patients will go into spontaneous remission
1/3 eventually improve with treatment
Remaining have progressive disease that is difficult to treat