Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

Multisystem granulomatous disorder

Idiopathic

Question 2

More common in?

Answer 2

Afro-CAribbeans

Women

Question 3

What are clinical features of acute sarcoidosis?

Answer 3

Fever
Erythema nodosum- painful bile-red raised lesions on shins
Polyarthralgia
Bilateral hilar lymphadenopathy

Question 4

What are clinical features of sarcoidosis?

Answer 4

Pulmonary disease:
CXR - bilateral hilar lymphadenopathy
Dry cough, progressive dyspnoea, reduced exercise tolerance and chest pain.

Non-pulmonary - lymphadenopathy, hepatosplenomegaly, events, conjuntivitis, glaucoma, neuropathy

Question 5

What tests for sarcoidosis?

Answer 5

Blood: Raised ESR
Lymphopenia,
Raised Ca, raised immunoglobulins

ECG - arrhythmia, BBB

Lung fusion testing - reduce lung volume, restrictive deficits

CXR - bilateral hilar lymphadenopathy, peripheral pulmonary infiltrates, bulla formation (honeycombing), pleural effusion

Question 6

What do you see on CXR?

What do you see of lung function test?

Answer 6

1 Bilateral hilar lymphadnopathy
2 BHL + peripheral pulmonary infiltrates
3: peripheral pulmonary infiltrates alone
4: bulla formation: honeycombing, pulmonary fibrosis, pleural effusion

Lung function test:
Restrictive deficit

Question 7

What Ix is diagnostic?

Answer 7

Tissue biopsy - shows non-caeseating granulomata

Question 8

What management for acute sarcoidosis?

Answer 8

Bed rest, NSAIDs

Question 9

What are indications for corticosteroids? What is given?

Answer 9

Parenchymal lung disease
Uveitis
Hypercalcaemia
Neuro/cardiac involvement

Prednisolone PO for 4-6 weeks

Question 10

What can you give in severe sarcoidosis?

Answer 10

Immunosuppressants - methotrexate, hydroxychloroquine, ciclosporin

Question 11

What are causes of bilateral hilarity lymphadenopathy?

Answer 11

Sarcoidosis
Infection - TB
Malignancy
Organic dust disease
Pneumoconioses
Metastatic disease
Hypersensitivity pneumonitis