Sarcoidosis

Question 1

Sarcoidosis?

Answer 1

• Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas.
• It is more common in young adults and in people of African descent

Question 2

Features?

Answer 2

• acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
• insidious: dyspnoea, non-productive cough, malaise, weight loss
• skin: lupus pernio
• hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

Question 3

Syndromes associated with sarcoidosis?

Answer 3

Lofgren’s syndrome:

• is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL),
• erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis

In Mikulicz syndrome*:

• there is enlargement of the parotid and lacrimal glands due to sarcoidosis,
• tuberculosis or lymphoma

Heerfordt’s syndrome (uveoparotid fever):

• there is parotid enlargement, fever and uveitis secondary to sarcoidosis
• *this term is now considered outdated and unhelpful by many as there is a confusing overlap with Sjogren’s syndrome*