Sketchy Path: Sarcoidosis and Berylliosis

Question 1

Sarcoidosis presents with _______________ granulomas.

Answer 1

non-caseating (like the intact cages)

Question 2

Weirdly, sarcoidosis is more common in _____________.

Answer 2

non-smokers (like the “No Smoking” sign above the field)

Question 3

Sarcoidosis is not fully understood, but it is known to result from aberrant activation of ____________.

Answer 3

CD4 cells (like the team: “Squires”… and there’s four of them on the poster)

Question 4

What bronchoalveolar lavage test can be done to diagnose sarcoidosis?

Answer 4

CD4:CD8 ratio greater than 2

Think of the kid drinking the BAL bottle beneath the Squires poster.

Question 5

What skin test is done to help diagnose sarcoidosis?

Answer 5

Anergy to antigens

In those with sarcoidosis, the CD4 cells are stuck in the lungs and cannot help mount the type IV hypersensitivity reaction in the skin. Thus, Candida antigen tests will be negative.

(Think of the kid with the feather: he cannot wake his sleeping team mate.)

Question 6

Sarcoidosis can cause what serum finding?

Answer 6

Hypergammaglobulinemia

The aberrant CD4 cells can activate a suite of B cells and induce Ig production.

(Think of the dangling set of different colored keys on the cage.)

Question 7

Multinucleated giant cells can have what two inclusions in granulomas?

Answer 7

• Asteroid stellate bodies (like the stars on the soccer balls in the center)
• Schaumann bodies: concretions of calcium that appear purple on H&E (like the SHow MAN who is bragging about his goal and spilling milk on his purple shoes)

Question 8

What x-ray findings do those with sarcoidosis have?

Answer 8

Hilar fullness and lymphadenopathy (like the kid sitting in the pulmonary fibrosis tree with the soccer balls near the mediastinum)

Question 9

What symptoms are common in sarcoidosis?

Answer 9

•Dyspnea on exertion (guy out of breath)
•Dry cough (girl coughing)
•Weight loss (skinny goalie)
•Fever (goalie with flame bandana)
• Erythema nodosum (shin guards with red dots)
• Painless skin nodules (gravel on the player that he’s not concerned about)
•Lupus pernio: a lupus-like malar rash (like the purple paint on the player’s face)
• Uveitis (kid with red goggles)
•Optic neuritis (like the streetlights with severed cords)
Dry mouth and dry eyes (goalie with uveitis goggles trying to squeeze out the last drop from his bottle)

Question 10

The lesions of erythema nodosum can be __________.

Answer 10

painful (like the player in pain holding his legs)

Question 11

True or false: the sores in erythema nodosum do not contain granulomas.

Answer 11

True. No granulomas in erythema nodosum. However, the painless nodules found elsewhere in the body do contain granulomas.

Question 12

The granulomas in sarcoidosis can also present in what tissues?

Answer 12

• Liver (cow with hepatomegaly spot)
• Heart (guy stuck in net with heart shirt)
• Skin (nodules like gravel)

Question 13

Granulomas accomplish which step in vitamin D activation?

Answer 13

1-alpha hydroxylation (same as in the kidney)

Think of the 1-alpha electrical box in front of the kid raising the calcium cup.

Question 14

The hypercalcemia of sarcoidosis can lead to ____________.

Answer 14

kidney stones (like the rocks in the milk)

Question 15

Sarcoidosis can also present with elevated ___________ values.

Answer 15

ACE (like the referee raising the ace card)

Question 16

True or false: the most common outcome of sarcoidosis is progressive respiratory failure.

Answer 16

False. Most cases resolve spontaneously in 3-5 years and can be sped along with steroids (like the moon balls).

Question 17

Like sarcoidosis, berylliosis can present with granulomas, but they more often appear in ______________.

Answer 17

the upper lobes (like the airplane parts falling on the upper part of the lung tree)