Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

Multi-system disorder of unknown disease

Question 2

How is sarcoidosis staged?

Answer 2

Classified one to four based on +/- bihilar lymphoidopathy (BHL) and +/- presence of infiltrates
Stage 1 - BHL only
Stage 2 - BHL + parenchymal infiltrates
Stage 3 - Parenchymal infiltrates only
Stage 4 - Advanced pulmonary fibrosis (Honeycombing)

Question 3

What are the clinical features of acute sarcoidosis?

Answer 3

Fever, erythema nodosum, polyarthralgia, bilateral hilar lymphodenopathy

Question 4

What are the pulmonary manifestations of sarcoidosis?

Answer 4

Chest X-ray with BHL +/- infiltrates or fibrosis, dry cough, progressive breathlessness, reduced exercise tolerance, chest pain

Question 5

What are the extra-pulmonary manifestations of sarcoidosis?

Answer 5

Hepatomegaly, splenomegaly, uveitis, conjunctivitis, terminal phalangeal bone cysts, enlargement of lacrimal and parotid glands, Bell’s palsy, neuropathy, erythema nodosum, lupus pernio (blue spots), restrictive myopathy, hypercalcemia, pituitary dysfunction

Question 6

What are the tests to diagnose sarcoidosis?

Answer 6

Chest x-ray (see staging), ECG (increase arrhythmia/bundle branch block), tissue biopsy (non-caseating granulomata), CT/MRI

Question 7

What is the management for acute sarcoidosis?

Answer 7

NSAIDs and bedrest

Question 8

What is the management for sarcoidosis?

Answer 8

Patients with BHL do not require treatment, mostly recovers spontaneously.
Corticosteroids (prednisolone)
When severe, IV methylprednisolone/ immunosuppressants (methotrexate, hydroxychloroquinolone, ciclosporin, cyclophosphamide)