Sarcoidosis Flashcards
What is sarcoidosis?
Granulomatous inflammatory condition affecting multiple systems
What are granulomas?
nodule of inflammation filled with macrophages
Who does sarcoidosis commonly affect?
which age ranges?
black people
women
two peaks in incidence: early adulthood, 60’s
What are the pulmonary features of sarcoidosis?
signs
symptoms
what is the prognosis?
- abnormal CXR with bilateral hilar lymphadenopathy
- pulmonary fibrosis
- pulmonary nodules
symptoms
- dry cough
- progressive dyspnoea
- reduced exercise tolerance
- chest pain
in 10-20% symptoms progress with concurrent deterioration of lung function
What are the extra pulmonary features of sarcoidosis?
systemic
- fever
- fatigue
- weight loss
Liver:
- liver nodules
- cirrhosis
- cholestasis
Skin
- erythema nodosum
- Lupus pernio (raised purple skin lesions commonly nose and cheeks)
- granulomas develop in scar tissue
Eyes
- uveitis
- conjunctivitis
- optic neuritis
Kidney
- hypercalcaemia
- nephrocalcinosis
- interstitial nephritis
Heart
- BBB, heart block
- myocardial involvement
CNS
- nodules
- pitituitry involvement (diabetes insipidus)
- encephalopathy
PNS
- facial nerve palsy
- mononeuritis complex
MSK
- arthralgia
- arthritis
- myopathy
Why does sarcoidosis cause hypercalcaemia?
Macrophages inside the granulomas cause an increased conversion of vitamin d to its active form - 1,25-dihydroxycholecalciferol
How does acute sarcoidosis typically present and what is the name for it?
What is the prognosis?
Lofgren’s syndrome
- erythema nodosum
- bilateral hilar lymphadenopathy
- swinging fever
- polyarthralgia
very good prognosis - usually resolves spontaneously
How does the typical exam patient present?
- 20-40 year old black female
- presenting with dry cough and SOB
- may have nodules on shin suggesting erythema nodosum
What is Heerfordt’s syndrome?
uveoparotid fever
- parotid enrlagement
- uveitis
- fever
secondary to sarcoidosis
How does insidiuous sarcoidosis present?
- SOB
- dry cough
- malaise
- weight loss
What investigations would you do for sarcoidosis?
Bloods
Calcium
others:
- raised serum ACE in 60%, non specific
- raised ESR, CRP
- hypercalcaemia
- raised immunoglobulins
- raised LFTs (if liver involvement)
calcium:
24 hr urine
- CXR
- Lung function tests
- Biopsy
- CT/MRI
- Bronchoalveolar lavage
What would you expect to see in CXR
stage 0 = normal
stage 1 = bilateral hilar lymphadenopathy (BHL)
stage 2 = BHL + interstitial infiltrates
stage 3 = diffuse interstitial infiltrates only
stage 4 = diffuse fibrosis
What would you expect to see in biopsy?
where can you take it?
DIAGNOSTIC
non caseating granulomas
lung, liver, lymph nodes, skin nodules, lacrimal glands
What can you expect to see in lung tests?
spirometry - restrictive features
reduced lung volume
How would you manage sarcoidosis first line?
no treatment, patients with mild or no symptoms often resolve spontaneously
