Sarcoidosis (pathology)

Question 1

What is sarcoidosis?

Answer 1

Multisystem granulomatous disorder/unknown aetiology

Type 4 hypersensitivity (T cell mediated)

Question 2

What is variable fibrosis?

Answer 2

Honey comb lung

Question 3

Risk factors for sarcoidosis

Answer 3

• young adults
• female
• temperate climates

European—> skin, eye, LN
Japanese—> cardiac
Black American —> progressive sarcoid

Question 4

How does sarcoidosis normally present? (Young adults, incidental CXR, symptomatic)

Answer 4

1. Young adult
   - acute arthralgia
   - erythema nodosum
   - bilateral hilar lymphadenopathy

2.Incidental abnormal CXR/CT- asymptomatic

3.SOB, cough + abnormal CXR 
#1 resolve in 2 y. 
#2/3 resolve, persist or progress

Question 5

Complications of sarcoidosis

Answer 5

• progressive respiratory failure
• bronchiectasis
• aspergilloma, haemoptysis, pneumothorax

Question 6

Investigations of sarcoidosis

Answer 6

• clinical findings
• CXR
  • Hilar lymphadenopathy
  • spotty lungs
  • interstitial change
  • fibrotic stage
• CT
• Pulmonary function tests
• Bloods, urinalysis (serum Ca2++ and ACE)
• ECG
• TB skin test
• Eye exam (anterior uveitis)
• Transbronchial biopsy/EBUS
• Mediastinoscopy/ video assisted thoracoscopic (VAT) lung biopsy

Question 7

How is mild sarcoidosis treated (no symptoms, no vital organ impaired, normal lung function)?

Answer 7

No treatment

Question 8

How are erythema nodosum/arthralgia treated?

Answer 8

NSAIDs

Question 9

How are skin lesions, anterior uveitis, cough treated?

Answer 9

Topical steroids

Question 10

How is Cardiac, neuro, eye disease (no response to topical Rx), Hypercalcaemia treated?

Answer 10

Systemic steroids

Prednisolone