Sarcoidosis

Question 1

What is sarcoidosis

Answer 1

Chronic inflammatory granulomatous disorder

Causing formation of granulomas which contain macrophages

Question 2

Who is sarcoidosis common in?

Answer 2

20-39 and around 60 years
Women
Black ethnicity

Question 3

Signs and symptoms of sarcoidosis

Answer 3

Dry cough
Dyspnoea
Reduced exercise tolerance
CP
Clubbing
Fine crackles

Question 4

Extrapulmonary manifestations of sarcoidosis?

Answer 4

Skin:
Erythema nodosum
Lupus pernio
Hyper/hypopigmentation of skin

Neurological:
Nodules
Diabetes insipidus
Encephalopathy
Facial nerve palsy
Mononeuritis multiplex

Eyes:
Uveitis
Glaucoma

Cardiac:
Bundle branch block
Heart block
Myocardial muscle sarcoidosis

Abdominal organomegaly

Liver:
cholestasis, cirrhosis, liver nodules

Kidneys:
Kidney stones
Nephrocalcinosis
Interstitial nephritis

Bones:
Arthralgia
Arthritis
Myopathy

Systemic symptoms: fever, fatigue, weight loss

Question 5

Lung changes caused by sarcoidosis?

Answer 5

Mediastinal lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules

Question 6

What is Lofgrens’ syndrome

Answer 6

Specific presentation of sarcoidosis with triad of symptoms:

Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia

Question 7

Investigations for sarcoidosis?

Answer 7

Bloods:
Serum ACE - raised
Serum calcium - raised

CXR:
hilar lymphadenopathy

High resolution CT:
pulmonary nodules

MRI:
CNS involvement

PET scan:
show active inflammation

Histology via US guided biopsy of mediastinal LNs. Findings: non caseating granulomas with epithelioid cells

Urine ACR for proteinuria

Question 8

Managament of sarcoidosis?

Answer 8

Conservative management if mild/asymptomatic

1st line: Oral steroids for 6-24 months WITH bisphosphonates

2nd line: Methotrexate

Lung transplant if severe