Sarcoidosis Flashcards
which demographic is associated with sarcoidosis?
Young adulthood 60s Women>men Black > other groups E.g. 20-40 year old, black female, dry cough and SOB, nodules on shins
what is the cause of sarcoidosis?
unknown
what is the underlying pathology of sarcoidosis?
Granulomatous, inflammatory conditions
Multi-system involvement
what is the inflammatory process of sarcoidosis?
Granulomas nodules of inflammation full of macrophages (also activated T cells)
Therefore increased production of TNF, IFN-γ, IL-2, IL-8, IL-10, IL-12, IL-18, IL-23 and TGF-β = TH1 response
Periphery cells suppress IL-2 – allows for latent state
what are the systemic symptoms of sarcoidosis?
fever, fatigue, weight loss
what are the respiratory symptoms of sarcoidosis?
= interstitial lung disease
mediastinal lymphadenopathy
pulmonary fibrosis
pulmonary nodules
what are the liver symptoms of sarcoidosis?
liver nodules, liver cirrhosis, cholestasis
what are the eye symptoms of sarcoidosis?
uveitis, conjunctivitis, optic neuritis
what are the skin symptoms of sarcoidosis?
Erythema nodosum – tender red nodules on shins, inflammation of subcutaneous fat
Lupus pernio – raised purple leisions, tip of nose+across cheeks
Granulomas in scar tissue
what are the cardio symptoms of sarcoidosis?
Bundle branch block
heart block
granulomas can affecr muscle - HF
what are the renal symptoms of sarcoidosis?
Kidney stones (hypercalcaemia)
Nephrocalcinosis (calcium deposist in kidneys)
Interstitial nephrotis
CNS – nodules in brain, pituitary involvement (diabetes), encephalopty
PNS – bells palsy, mononeuritis multiplex
what are the skeletal symptoms of sarcoidosis?
arthralgia, arthritis, myopathy
what are the acute symptoms of sarcoidosis?
o Erythema nodosum o Bilateral hilar lymphadenopathy o Arthritis o Uveitis, parotitis o Fever
what are the chronic symptoms of sarcoidosis?
o Lung infiltrates (alvolitis) or fibrosis o Skin infiltrates o Peripheral lymphadenopathy o Hypercalcaemia o Hepatomegaly o Splenomegaly o Neurological – bells palsy, neuropathy, meningitis o Renal stones o Pituitary dysfunction
what are the insidious symptoms of sarcoidosis?
dyspnoea, non-productuve cough, malaise, weight loss
what is Lofgrens Syndrome?
Triad of:
Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia
what is the gold standard test for sarcoidosis?
histology - biopsy
what histological features will be seen in sarcoidosis?
non caseating granulomas with epithelioid cells
what blood tests would be done in sarcoidosis?
Raised Serum ACE
Raised serum Calcium
Soluble IL-2 receptors (raised)
Inflam markers (raised)
What imaging tests would be done in sarcoidosis?
Chest Xray - Hilar lymphatedopathy
CT – hilar lymphadenopathy and pulmonary nodules
MRI – CNS involvement
PET – active areas of inflammation
what tests would be used to assess other organ involvement in sarcoidosis?
U&E, urine dipstick, urine albumin creatinine ratio LFTS Opthalmology review ECG + echo Spirometry – RESTRICTIVE Abdomen US Bone Xray – punched out leisons
what is the staging of sarcoidosis?
Stage 0 – normal CXR
Stage 1 – BHL – bilateral hilar lymphadenopathy
Stage 2 – BHL + Infiltrates
Stage 3 – Peripheral pulmonary infiltrates alone
Stage 4 – Progressive pulmonary fibrosis ± bulla (honeycombing on CXR
what is the treatment of stage 0 and 1 sarcoidosis?
no treatment
what is the treatment of stage 2 and acute disease
NSAIDs and bed rest
