Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

multisystem chronic inflammatory condition characterised by formation of non-caseating epithelioid granulomata

Question 2

In order of predilection, which organs are effected by sarcoidosis ?

Answer 2

Lungs + thoracic cavity
Skin + eyes 
Liver
Heart
Nervous system.

Question 3

Give 3 epidemiological facts on sarcoidosis

Answer 3

Most common in Northern European/Scandinavian + African-American individuals.
Usually in adults < 50
Usually sporadic

Question 4

What are 6 constitutional symptoms that may be experienced by a patient with sarcoidosis?

Answer 4

Fever
Night sweats
Malaise
Fatigue
Weight loss.
Heerfordt's syndrome (inflammation of submaxillary/ parotid glands with uveitis + facial nerve palsy)

Question 5

List 3 respiratory symptoms seen in sarcoidosis

Answer 5

Dry cough
Dyspnoea
Chest discomfort.

Question 6

List 3 skin manifestations

Answer 6

Maculopapular eruptions 
Erythema nodosum  
Lupus pernio (red-blue infiltrations of nose + cheeks)

Question 7

List 3 musculoskeletal manifestations in sarcoidosis

Answer 7

Bone cysts (e.g. dactylitis)
Polyarthralgia
Myopathy

Question 8

List 4 ocular manifestations in sarcoidosis

Answer 8

Dry eyes
Glaucoma
Uveitis
Blurred vision

Question 9

What is Neurosarcoidosis caused by? What may this result in?

Answer 9

Infiltrative nerve lesions: 
Lymphocytic meningitis  
Cranial nerve palsies: Bells palsy
Peripheral neuropathy 
Facial numbness

Question 10

List 3 cardiac manifestations of sarcoidosis

Answer 10

Arrhythmia
Cardiomyopathy
Congestive heart failure

Question 11

What will be seen in the bloods of a patient with sarcoidosis?

Answer 11

High serum ACE
High calcium
High ESR
FBC: WCC low due to lymphocyte sequestration in the lungs
Immunoglobulins: polyclonal hyperglobulinaemia
LFTs: high ALP + GGT

Question 12

What is found in 24 hr urine collection in sarcoidosis?

Answer 12

Hypercalciuria

Question 13

Describe the staging of sarcoidosis based on CXR findings

Answer 13

Stage 0: normal 
Stage 1: bilateral hilar lymphadenopathy 
Stage 2: BHL + pulmonary infiltrates
Stage 3: pulmonary infiltrates, no BHL
Stage 4: overt fibrotic disease

Question 14

What can high resolution CT scanning show in sarcoidosis?

Answer 14

Interstitial lung disease

Question 15

What do pulmonary function tests show in sarcoidosis?

Answer 15

Low FEV1

FVC shows restrictive picture

Question 16

What is found on bronchoscopy/ bronchiavleolar lavage in sarcoidosis?

Answer 16

High lymphocytes

High CD4: CD8 ratio

Question 17

What is seen on transbronchial/ lymph node biopsy in sarcoidosis?

Answer 17

Non-caseating granulomas consisting of: 
Epithelioid cells (activated macrophages)  
Multinucleate Langerhans cells  
Mononuclear cells (lymphocytes)

Question 18

What is the standard first line treatment for sarcoidosis?

Answer 18

Oral glucocorticoids

Question 19

What are 3 environmental risk factors for development of sarcoidosis?

Answer 19

Agricultural exposure
Insecticides
Microbial bioaerosols

Question 20

Name 1 protective factor against sarcoidosis

Answer 20

Cigarette smoking

Question 21

List 4 markers of poor prognosis in sarcoidosis

Answer 21

Pulmonary HTN
Extensive disease
Lung function impairment
Age