Sarcoidosis

Question 1

What type of sim manifestation is associated with sarcoidosis ?

Answer 1

Erythema nodosum

Question 2

Risk factors for sarcoidosis ?

Answer 2

African descendants

Question 3

Acute clinical presentation of sarcoidosis

Answer 3

LOFGREN SYNDROME :

fever,
joint pain - polyarthralgia
erythema nodosum, lymphadenopathy

Question 4

Insidious presentation of sarcoidosis ?

Answer 4

dyspnoea,
non-productive cough,
malaise, weight loss

skin: lupus pernio - indolent reddish-purple plaques and nodules on the nose, cheeks, lips, ears and digits

Question 5

Other syndromes associated with sarcoidosis

Answer 5

In Mikulicz syndrome
enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma

Heerfordt’s syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis

Question 6

C

Question 7

What is seen on bloods for sarcoidosis?

Answer 7

Hypercalcemia -hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

Question 8

What is seen in CXR in sarcoidosis

Answer 8

Non caseating granuloma

Question 9

Stages of sarcoidosis

Answer 9

stage 0 = normal
stage 1 = bilateral hilar lymphadenopathy (BHL)

stage 2 = BHL + interstitial infiltrates (granuloma)

stage 3 = diffuse interstitial infiltrates only

stage 4 = diffuse fibrosis

Question 10

X

Question 11

X

Question 12

X

Question 13

M

Question 14

Complication of sarcoidosis ?

Answer 14

Reoccurrence in 2/3 of people

Question 15

Factors associated with poor prognosis ?

Answer 15

In sarcoidosis - if no erythema nodosum
Insidious onset
Extrapulmonary manifestation - lupus pernio
lupus splenomegaly
Black people
CXr - stage 3-4 features

Question 16

What is lupus pernio?

Answer 16

bluish-red or violaceous nodules and plaques over the nose,

Question 17

Mx of lofgren syndrome ?

Answer 17

has a good prognosis

and does not usually require any treatment;

it will self-resolve within a year or so.

Indications for immunosuppressive treatment include splenic/hepatic/renal/cardiac involvement, lupus pernio, hypercalcemia, eye/CNS involvement or deteriorating pulmonary function tests or deteriorating chest x-ray changes

Question 18

Mx of sarcoidosis

Answer 18

Indications for steroids

patients with chest x-ray stage 2 or 3 disease who ARE symptomatic.

Hypercalcemia

eye, heart or neuro involvement
-uveitis