Week Three - Case Three Flashcards
what is sarcoidosis
multisystem granulomatous disorder of unknown aetiology
what does sarcoidosis produce
often produces non-caveating epithelioid granulomas, which can occur at any site in the body.
they give the appearance of TB on a chest x-ray
what races are highest risk of sarcoidosis
black africans followed by Scandinavians
what age is the typical presentation
25-45 years
which parts of the body are most commonly affected
Lungs are most commonly affected, followed by eyes and skin.
The liver is also often affected, but this is rarely clinically significant
Rarely it an affect the heart and nervous system
what percentage of patients are asymptomatic
50%
what are the chest associated symptoms
Dry cough
Chest pain
Fever
Dyspnoea (usually progressive)
A restrictive pattern may be seen on spirometry
Lymphadenopathy
Crackles on auscultation
Fatigue
Malaise
Weight loss
Weakness
what are the range of non-pulmonary symptoms sarcoidosis presents with - these make it a differential diagnosis for almost any unidentifiable disease
Hepatomegaly, splenomegaly, lymphadenopathy, Bell’s palsy, uveitis, conjunctivitis and cataracts.
what are the skin signs and symptoms
Papules – often resembling Rosacea, or the malaria rash seen in SLE
Plaques that may mimic psoriasis
Erythema nodosum
what are the eye signs and symptoms
Occur in 20% of patients
Typically a uveitis
what are the neurological symptoms
Granulomas can form anywhere int he nervous system
Therefore – can cause any neurological sign
Sometimes cases Bell’s Palsy
what is a granuloma
collection of monocular cells and macrophages (WBCs) surrounded by lymphocytes, plasma cells, mast cells, fibroblasts and collagen.
where do granulomas tend to by distributed in the lung
along the line of lymph nodes
what would the blood results be in sarcoidosis
FBC – may cause anaemia or raised WCC
ESR – often raised
U+E
LFTs – may be derranged
Serum ACE (angiotensin converting enzyme)
Elevated in 60% of cases
Falls with treatment
Not routinely used for diagnosis or monitoring of treatment (lung function and CXR are better indicators)
what are the classical findings on X ray of sarcoidosis
The classical finding is hilar lymphadenopathy, where there are clear lung fields, with ‘fluffy’ opacities in the hilar region. Other changes may include lung infiltrates and fibrosis.
It can also cause non-specific CXR changes.
