Sarcoidosis

Question 1

Define Sarcoidosis?

Answer 1

Multisystem granulomatous inflammatory disorder

Question 2

What is the aetiology of Sarcoidosis?

Answer 2

Transmissible agents (e.g. viruses)
Environmental triggers
Genetic factors have all suggested

Question 3

What is the pathogenesis of Sarcoidosis?

Answer 3

An unknown antigen is presented on MHC class 2 complexes on macrophages to CD4+ T-lymphocytes 
These accumulate and release cytokines 
This leads to the formation of non-caseating granulomas in organs

Question 4

What is the epidemiology of Sarcoidosis?

Answer 4

Most common in AFRICANS and SCANDINAVIANS

Can occur at any age but tends to be in adults > 50 yrs

Question 5

What are the general symptoms of Sarcoidosis?

Answer 5

Fever 
Malaise 
Weight Loss 
Bilateral parotid swelling 
Lymphadenpathy 
Hepatosplenomegaly

Question 6

What are the Pulmonary symptoms of Sarcoidosis?

Answer 6

Breathlessness
Dry cough
Chest discomfort
Minimal clinical signs

Question 7

What are the Musculoskeletal Symptoms of Sarcoidosis?

Answer 7

Bone Cysts (e.g. dactylitis)
Polyarthralgia
Myopathy

Question 8

What are the eye symptoms of Sarcoidosis?

Answer 8

Keratoconjunctivitis Sicca
Uveitis
Papilloedema

Question 9

What is Keratoconjunctivitis Sicca?

Answer 9

Inflammation of the conjunctivitis and surrounding tissues due to the eyes being dry

Question 10

What are the Skin Symptoms of Sarcoidosis?

Answer 10

Lupus pernio
Erythema nodosum
Maculopapular eruptions

Question 11

What is Lupus pernio?

Answer 11

red-blue infiltrations of the nose, cheeks, ears and terminal phalanges

Question 12

What are the neurological symptoms of Sarcoidosis?

Answer 12

Lymphocytic meningitis
Space-occupying lesions 
Pituitary infiltration 
Cerebellar ataxia 
Cranial nerve palsies
Peripheral neuropathy

Question 13

What are the cardiac symptoms of Sarcoidosis?

Answer 13

Arrhythmia 
Bundle branch block 
Pericarditis 
Cardiomyopathy 
Congestive cardiac failure

Question 14

What investigations do you do for Sarcoidosis?

Answer 14

Bloods 
24 hr Urine Collection 
CXR 
High-Resolution CT Scan
Gallium Scan
Pulmonary Function Tests 
Bronchoscopy and Bronchoalveolar Lavage 
Transbronchial Lung Biopsy (or lymph node biopsy)

Question 15

What bloods do you do for Sarcoidosis?

Answer 15

High Serum ACE
High calcium 
High ESR 
FBC 
Immunoglobulins
LFTs

Question 16

What do you see on FBC for Sarcoidosis?

Answer 16

WCC may be low due to lymphocyte sequestration in the lungs

Question 17

Why do we investigate Immunoglobulins for Sarcoidosis?

Answer 17

Polyclonal hyperglobulinaemia

Question 18

What LFTs do we do for Sarcoidosis?

Answer 18

High ALP + GGT

Question 19

Why do we do a 24 hr urine collection for Sarcoidosis?

Answer 19

Hypercalciuria

Question 20

What do we see on CXR for Sarcoidosis?

Answer 20

Stage 0 - may be clear
Stage 1 - bilateral hilar lymphadenopathy
Stage 2 - stage 1 with pulmonary infiltration and paratracheal node enlargement
Stage 3 - pulmonary infiltration and fibrosis

Question 21

Why do we do High-Resolution CT Scan for Sarcoidosis?

Answer 21

Check for diffuse lung involvement

Question 22

Why do we do Gallium Scan for Sarcoidosis?

Answer 22

Shows areas of inflammation

Question 23

Why do we do Pulmonary Function Tests for Sarcoidosis?

Answer 23

Low FEV1

FVC shows restrictive picture

Question 24

Why do we Bronchoscopy and Bronchoalveolar Lavage for Sarcoidosis?

Answer 24

High lymphocytes

High CD4:CD8 ratio

Question 25

Why do we do Transbronchial Lung Biopsy for Sarcoidosis?

Answer 25

Shows non-caseating granulomas consisting of:

• Epithelioid cells (activated macrophages)
• Multinucleate Langerhans cells
• Mononuclear cells (lymphocytes)