Sarcoidosis

Question 1

What is sarcoid?

Answer 1

A multi-system granulomatous(epithelioid & giant cell) disorder or unknown aetiology.
Primarily affects the lungs (mostly upper zones)

Question 2

What are the stages of pulm. sarcoidosis?

Answer 2

0 - normal CXR
1 - Bilateral Hilar Lymphadenopathy
2 - BHL + Pulm. Infiltrates
3 - Pulm. Infiltrates 
4 - Progressive Fibrosis, Bulla formation (honeycombing) and pleural involvement

Question 3

Who is most commonly affected by Sarcoid?

Answer 3

African Americans
Young Adults (20-40)
Women > men

Question 4

hwo does sarcoid present?

Answer 4

Dyspnoea
Cough
Lower Exercise Tolerance
Chest Pain

Erythema Nodosum & arthralgia

Uveitis/Conjunctivitis/Glaucoma

Question 5

How is sarcoid investigated?

Answer 5

ABG
FBC
Serum Calcium & ACE (both raised)
PFT - Restrictive Pattern & reduced gas transfer
Raised LFTs.
Urinalysis - Hypercaliuria

CXR:

• BHL
• Pulm. Infiltrates
• Granulomas
• Fibrosis

CT (honeycombing more obvious on CT)

Bronchoscopy

• EBUS
• Biopsy

VATS (video assisted thoracoscopy) biopsy
Mediastinoscopy

Question 6

How is stage 1 sarcoid treated?

Answer 6

Mild acute sarcoid can be left and usually resolves with rest. NSAIDs can be added for erythema nodosum & arthralgia

Question 7

How is more severe sarcoid treated?

Answer 7

Oral Prednisalone
IV methylprednisalone if necessary
Topical steroids for uveitis & skin lesions

Question 8

What other treatments are there for sarcoid?

Answer 8

Lung transplant
Anti-TNFalpha treatments
Immunosupressents e.g. methotrexate