Sarcoidosis

Question 1

What is it?

Answer 1

Multisystem granulamotous disorder

Question 2

Clinical 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)
other: bilateral parotid swelling, anterior uveitis

Question 3

Lofgren’s Syndrome

Answer 3

This is a specific presentation of sarcoidosis. It is characteristic by a triad of:

Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia (joint pain in multiple joints)

Question 4

Investgations

Answer 4

Bloods: Raised ESR and ACE and hyperclacaemia

Chest x ray

Tissue biopsy: histology is gold standard - of lupus pernio or bronchoscopy for biopsy of mediastinal lymph nodes
showing: non-caseating granulomas with epitheliod cells

Question 5

Management

Answer 5

Acute: NSAIDs and self limiting

Management: Steroids - prednisolone and hydrocortisone
2nd line azathioprine