Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

A multi-system disorder of unknown aetiology characterised by non-caseating (necrotizing) granulomas.

Question 2

What is the epidemiology of sarcoidosis?

Answer 2

More common in young adults and in people of African descent

Question 3

What are the features of sarcoidosis?

Answer 3

Acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia.
Insidious: dyspnoea, non-productive cough, malaise, weight loss
Skin: lupus pernio (pathagnomic)
Hypercalcaemia.

Question 4

What syndromes are associated with sarcoidosis?

Answer 4

Lofgren’s syndrome
Mikulicz syndrome
Heerfordt’s syndrome

Question 5

What are the investigations of sarcoidosis?

Answer 5

Clinical diagnosis

ACE levels (disease monitoring)
Routine bloods: hypercalcaemia, raised ESR.

Chest x-ray:
Bilateral hilar lymphadenopathy, interstitial infiltrates, diffuse fibrosis ‘ground-glass’.

Spirometry: restrictive defect

Tissue biopsy: non-caseating granulomas

Question 6

What is the management of sarcoidosis?

Answer 6

Steroids:
Indications: Stage 2-3 disease who are symptomatic, hypercalcaemia, eye, heart or neuro involvement.