Sarcoidosis

Question 1

what is the etiology of sarcoidosis ?

Answer 1

unknown

infectious

enivornmnetal and occupational exposure

Question 2

what is the pathology of sarcoidosis ?

Answer 2

non caseating epithelia granulomas

dominant cell is the epithelia cells , cd4 lymphocytes and mature macrophages

they often under go fibrosis - STELLATE SCAR left behind

Question 3

symptoms of sarcoidosis ?

Answer 3

resolution within weeks to several months

asymptomatic sarcoidosis - picked by hilar adenopathy

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acute sarcoidosis with or without erythema nodosum

lofgren syndrome : acute onset of erythema nodosum (red nodules the lowe extremities typically the ankles , feet and knees)
, bilateral hilar adenopathy , fever , polyarthrtisi , uveitis

pulmonary sarcoidosis

cough ,
progressive and insidious shortened of breath

hemoptysis with sputum production - fibrocystic sarcoidosis

chest tightness and wheezing = endobronchial disease

Question 4

what is the diagnosis ?

Answer 4

chest x ray or CT

stage 0 - normal

stage 1- hilar adenopathy , interstitial infiltrations

stage 2 - bilateral hilar adenopathy and pulmonary infiltrates - with fine linear markings and small reticulonodular in the mid and upper zones

stage 3 - interstitial infiltrates seen without evidence of hilar adenopathy

stage 5 - extensive fibrocystic disease

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pulmonary hypertension

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spirometry - restrictive
forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are reduced, however, the decline in FVC is more than that of FEV1, resulting in a higher than 80% FEV1/FVC

or obstructive impairment

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histology - by biopsy of skin
or enlarged superficial nodule

fiberoptic bronchoscopy - and tranbronchial biopsy

transbornchoscopic needle aspiration of intrathoraci lymph node

mediastinoscopy

BAL - lymphocytosis

lab - elevated ace and hypercalcemia

Question 5

what ar the extra pulmonary sarcoidosis findings ?

Answer 5

ocular sarcoidosis

cutaneous sarcoidosis

hepatic sarcoidosis

Question 6

management of sarcoidosis ?

Answer 6

prognosis influenced by the initial manifestations - leofgren syndrome
remission rates of 70-80 percent

stage 1 = 60-90 remission

extensive pulmonary fibrosis - rarely undergo remission

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stage 1 - excellent prognosis = no systemic therapy is required

leofgren syndrome - ranged with bed , rest and nsaids

indication for treatmnet fo sarcoidosis - threatened organ failure - such as severe occular, cardiac, hepatic or neurological disease

progressive pulmonary disease

prednisone drug therapy which becomes tapered
antimalarial drugs - chloroquine

anti inflammatory - pentoxyfyline

immunosuppressive therapies - azathioprine , methotrexate , infliximab