Sarcoidosis

Question 1

What is it?

Answer 1

Multisystem disorder of unknown aetiology- non caseating granulomas
Common in YA and people of african descent

Question 2

Features of Sarcoidosis

Answer 2

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio- PURPLE LESIONS
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

Question 3

Blood test results

Answer 3

• Raisedserum ACE. This is often used as a screening test.
  
  • Hypercalcaemia (rasied calcium) is a key finding.
  • Raisedserum soluble interleukin-2 receptor
  • Raised CRP
  • Raised immunoglobulins

Question 4

Chest X-Ray findings of Sarcoidosis

Answer 4

• Chest xray showshilar lymphadenopathy
  
  • High resolution CT thorax showshilar lymphadenopathyandpulmonary nodules
  • MRIcan showCNS involvement
  • PET scancan show active inflammation in affected areas

Question 5

Gold standard for confirming diagnosis of sarcoidosis

Answer 5

Histology from a biopsy

Done using a bronchoscopy with ultrasound guided biopsy of mediastinal lymph nodes

Question 6

Treatment

Answer 6

Non treatment is first line
Mild symptoms resolve spontaneously
Oral steroids- first line
Bisphosphonates- protect against osteoporosis whilst on steroids
Second line- methotrexate or azothioprine
Lung transplant