Sarcoidosis

Question 1

Definition

Answer 1

A multisystem granulomatous disorder of unknown origin

Question 2

How does it develop

Answer 2

• T-helper cells triggered to proliferate by cytokines released by Dendritic cells
• T- cells travel to hilarity lymph nodes and release pro-cytokines which encourage more inflammatory cells to divide ( macrophages/ T-cells/ B- cells)
• Leads to the development of granulomata which clump together in the lymph nodes
• Non caveating granulomas
• Sometimes macrophages can fuse together to form giant langhans cells

Question 3

Risk factors

Answer 3

• Women
• African American
• Family history

Question 4

What systemic response do the granulomas and giant cells lead to?

Answer 4

• Erythema nodosum in the legs
• Uveitis in the eyes
• Bilateral hilar lymphadenopathy
• Heart arrhythmia
• Fever/weight loss/ fatigue

Question 5

What are symptoms of sarcoidosis related to the lungs

Answer 5

• SOB

- cough

Question 6

Investigation

Answer 6

1-CXR- will reveal bilateral hilarity lymphadenopathy
2-Blood test:
-Calcium increases- triggered by XS vitamin D released by the macrophages
-Increased ACE
-Increased antibody count
3-Bronchoscopy: T-cells in the lung
4-Bronchial lavage

To determine aetiology:

• Kveim test
• Tuberculin test

Question 7

Kveim test

Answer 7

• Part of spleen of patient with known sarcoidosis is injected
• if non-caseating granulomas found 4-6 weeks later then test is positive

Question 8

What are the three main types of presentations

Answer 8

1- Young patient : Acute arrythalgia, Erythema nodosum, Bilateral hilarity lymphadenopathy
2- Incidental abnormal CXR
3-Abnormal CXR, SOB, cough

Question 9

Treatment

Answer 9

In most cases will resolve by itself
NSAIDs- arrythalgia/ erythema nodosum
Topical steroids - uveitis, cough
Systemic steroids for symptoms which do not respond to topical