Sarcoidosis Flashcards

1
Q

Sarcoidosis

A

Chronic granulomatous disorder of unknown cause

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2
Q

Type of granulomas

A

Non-caseating granulomas

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3
Q

Type of Hypersensitivity

A

IV - delayed hypersensitivity

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4
Q

Common systems involved

A

Lungs, lymph nodes, joints, liver, skin, eyes

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5
Q

What causes tissue damage & fibrosis?

A

Persistent immune activation

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6
Q

Pathology

A

Inhalation of unknown antigen => stimulates alveolar macrophages, CD4+ & CD8+ T cells & B cells within lung parenchyma => failure to clear antigen caused persistent stimulation & granuloma formation => Persistent immune activation leads to tissue damage & fibrosis, particularly in upper lobes.

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7
Q

Persons affected

A
  • Adults aged 20-40.
  • More common in female & Afro-Caribbean.
  • Highest in Northern Europe.
  • Less common in smokers.
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8
Q

Symptoms of Acute Sarcoidosis

A
  • Erythema nodosum.
  • Bilateral hilar lymphadenopathy.
  • Arthritis.
  • Uveitis.
  • Parotitis.
  • Fever.
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9
Q

Symptoms of Chronic Sarcoidosis

A
  • Lung infiltrates (alveolitis).
  • Skin infiltrates.
  • Peripheral lymphadenopathy.
  • Hypercalcaemia.
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10
Q

General Symptoms

A
  • Weight loss.
  • Malaise.
  • Polyurethaning.
  • Rash.
  • Bihilar lymphadenopathy.
  • Polyarthiritis.
  • Erythema nodosum.
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11
Q

Respiratory Symptoms

A
  • Dry cough.
  • Progressive dyspnoea.
  • Reduced exercise tolerance.
  • Chest pain.
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12
Q

Investigations

A

CXR, spirometry, DCLO, CT lungs, Tissue biopsy, blood test.

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13
Q

CXR

A
  • Bilateral hilar lymphadenopathy.

- Pulmonary infiltrates or fibrosis.

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14
Q

Spirometry

A

Normal restrictive pattern

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15
Q

DCLO

A

Normal or reduced

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16
Q

CT Lungs

A

Restrictive defect due to lung infiltrates.

17
Q

Blood Test

A
  • ACE levels as activity marker.
  • Raised calcium.
  • Increased inflammatory markers.
18
Q

Indications for Treatment

A
  • Interstitial lung disease.
  • Hypercalcemia.
  • Cardiac/neurological involvement/uveitis.
19
Q

Treatment of Acute Sarcoidosis

A
  • Often self-limiting: usually no treatment.

- If vital organ affected: Steroids.

20
Q

Treatment of Chronic Sarcoidosis

A
  • Oral or inhaled steroids usually required.

- Immunosuppression.

21
Q

Management

A

Monitor CXR & Pulmonary function for several years.