Sarcoidosis Flashcards
What is sarcoidosis?
multisystem chronic inflammatory condition characterised by formation of non-caseating epithelioid granulomata
What are non-caseating granulomas?
Non-necrotising nodules of inflammation + scarring
In order of predilection, which organs are effected by sarcoidosis ?
Lungs (up to 90% cases)
Skin (up to 30% cases)
Eyes (up to 30% cases)
Brain, Nervous system, Live, Heart
In which patient groups is sarcoidosis more common?
Young adults
People of African descent
Give 4 acute features of sarcoidosis
Erythema nodosum
Bilateral hilar lymphadenopathy
Swinging fever
Polyarthralgia
Give 4 insidious features of sarcoidosis
Dyspnoea
Non-productive cough
Malaise
Weight loss
List 4 pulmonary symptoms seen in sarcoidosis
Dyspnoea
Dry persistent cough
Wheezing
Non-cardiac chest pain (tightness/ pleuritic discomfort)
List 3 skin manifestations of sarcoidosis
Hyper-/ hypopigmentation
Erythema nodosum
Lupus pernio
What is Lupus pernio?
Bluish-red/ violaceous nodules + plaques over nose, cheeks + ears
What is the most common ocular manifestation of sarcoidosis?
Uveitis
List 3 cardiac manifestations of sarcoidosis
Arrhythmia
Congestive heart failure
Syncope
What electrolyte abnormality if characteristic of sarcoidosis? Why?
Hypercalcaemia
Macrophages in the granulomas cause conversion of vitamin D to its active form
3 features in bloods in sarcoidosis
Raised serum ACE
Hypercalcaemia
Raised ESR
Raised ALP
What is the use of ACE in diagnosis of sarcoidosis?
60% sensitivity
70% specificity
Not reliable in dx, but have a role in monitoring disease activity
What may be found in 24 hr urine collection in sarcoidosis?
Hypercalciuria
Describe the staging of sarcoidosis based on CXR findings
Stage 0: normal
Stage 1: bilateral hilar lymphadenopathy
Stage 2: BHL + interstitial infiltrates
Stage 3: diffuse interstitial infiltrates, no BHL
Stage 4: diffuse fibrosis
What can high resolution CT scanning show in sarcoidosis?
Interstitial lung disease
What may spirometry show in sarcoidosis?
Restrictive defect
What is seen on transbronchial/ lymph node biopsy in sarcoidosis?
Non-caseating granulomas consisting of:
Epithelioid cells (activated macrophages)
Multinucleate Langerhans cells
Mononuclear cells (lymphocytes)
What is the course of disease in 2/3 of patients with sarcoidosis?
Remits without Tx in ~2/3
What are the indications for corticosteroid treatment for sarcoidosis?
CXR stage 2-3 + symptomatic
Uveitis (Prednisolone PO)
Hypercalcaemia
Neurological/ cardiac involvement
Name 1 protective factor against sarcoidosis
Cigarette smoking
List 5 markers of poor prognosis in sarcoidosis
Insidious onset, Sx >6 months
Absence of erythema nodosum
Extrapulmonary manifestations e.g. lupus pernio, splenomegaly
CXR: stage III-IV features
Black African or Afro-Caribean ethnicity
List 3 syndromes associated with sarcoidosis
Lofgren’s syndrome
Mikulicz syndrome
Heerfordt’s syndrome
What is Lofgren’s syndrome?
Acute form of sarcoidosis characterised by:
Bilateral hilar lymphadenopathy
Erythema nodosum
Fever
Polyarthralgia
What is Mikulicz syndrome?
Enlargement of parotid + lacrimal glads due to sarcoidosis, TB or lymphoma
Now considered outdated as confusing overlap with Sjogren’s syndrome
What is Heerfordt’s syndrome?
aka Uveoparotid fever
Parotid enlargement + uveitis secondary to sarcoidosis
