Sarcoidosis

Question 1

what is sarcoidosis?

Answer 1

granulomatous inflammatory condition

nodules of inflammation that are full of macrophages

causes are unknown

Question 2

symptoms of sarcoidosis

Answer 2

chest symptoms
erythema nodosum (nodules on shin)
lymphadenopathy

can be asymptomatic (50%)
or severe, life threatening s+s

incidences: young adulthood and 60 year olds

Question 3

organs that sarcoidosis effects

Answer 3

lungs (90%) mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules

systemic symptoms
fever, fatigue, weight loss

liver (20%)
liver nodules, liver cirrhosis, cholestasis (slowing of bile)

eyes (20%)
uveitis, conjunctivitis, optic neuritis

skin (15%)

• erythema nodosum (tender red nodules on the shins) inflammation of the subcutaneous fat
• lupus pernio (raised purple coloured skin lesion on tip of nose / cheeks)
• granulomas in scar tissue

heart (5%)
heart block, BBB, HF

kidney (5%) kidney stones (hypercalcaemia)

CNS (nodules, pituitary involvement DI)

peripheral nervous system (bells palsy)

bones (arthralgia, arthritis)

Question 4

Lofgren’s syndrome

Answer 4

specific presentation sarcoidosis

triad:

1) erythema nodosum
2) bilateral hilar lymphadenopathy
3) polyarthralgia

Question 5

differential diagnosis for sarcoidosis

Answer 5

cough, lymphadenopathy, systemic symptoms

• tuberculosis
• lymphoma
• hypersensitivity pneumonitis
• HIV
• toxoplasmosis

Question 6

investigations for sarcoidosis

Answer 6

blood tests- U+E, urine dipstick, albumin:creatinine, LFT
serum ACE
soluble IL2 receptors
inflammatory markers (CRP) (immunoglobulins)
opthalmology review
ECG, echo
USS abdomen (liver, kidney)

histology
biopsy areas affected by sarcoidosis
non caveating granulmas with epithelioid cells

bronchoscopy ultrasound guided

Question 7

imaging of sarcoidosis

Answer 7

CXR (hilar lymphadenopathy)

high resolution CT of chest
(pulmonary nodules)

MRI (CNS involvement)

PET scan (active areas of inflammation)

Question 8

management of sarcoidosis

Answer 8

mild- no tx, resolves spontaenously

oral steroids (6-24 months) give bisphosphonate to protect bones

immunosuppressants (methotrexate, azathioprine)

severe- lung transplant

Question 9

prognosis of sarcoidosis

Answer 9

spon resolve in 60% patients

can progress to pulmonary fibrosis and pulmonary HTN

affects the heart= fatal arrhythmias

Question 10

sarcoidosis

Answer 10

microphages ingest fibers- collagen deposition
brown IRON blobs
irreversible dilation of bronchioles- signet ring sign
infolding of the ring

Question 11

mx sarcoidosis

Answer 11

treat with NSAIDS or steroid if severe