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Flashcards in Sarcoidosis Deck (18)
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what is sarcoidosis?

a non-caseating granulomatous (type 4 hypersensitivity) disease of unknown cause


The cause is unknown but what might be involved?

- an ineffective agent in a susceptible individual.
- imbalance of immune system with type 4 hypersensitivity


who is it less and more common in?

-less common in smokers
- more common in afro-caribbean populations


there is multisystem involvement which are the common and uncommon sites of involvement?

common: lungs, lymph nodes, joints, liver, skin, eyes

uncommon: kidneys, brain, permanent damage


what are the symptoms for acute sarcoidosis?

over the course of a week or two you will start to feel generally unwell and will often develop erythema nodosum

- sweats
- erythema nodosum
- bilateral hilar lymphadenopathy
- arthritis
- uveitis
- parotitis (inflammation of the salivary glands)
- fever


what are the symptoms and characteristics of chronic lymphadenopathy

- lung infiltrates (alveolitis)
- skin infiltrations
- peripheral lymphadenopathy
- hypercalcaemia
- can get end-organ damage such as renal, myocardial, neurological, hepatitis, splenomegaly


what should be on the differential diagnosis

- TB (tuberculin skin test negative)
- lymphoma
- carcinoma
- fungal infection


what investigations should be done to lead to a diagnosis?

- tissue biopsy
- blood test


what would the CXR show?

bilateral hilar lymphadenopathy, nodules along fissures


what would a CT show maybe?

peripheral nodular infiltrate


tissue biopsy ?

(e.g. transbronchial, skin, lymph node)
non-caseating granuloma


what would the blood tests show?

- raised calcium
- increased inflammatory markers
- renal function


what are the severity marker investigations ?

ANGIOTENSIN CONVERTING ENZYME: act as an activity marker. This is NOT a diagnostic marker as it is quite non-specific

PULMONARY FUNCTION: restrictive defect due to lung infiltrations.
- this is really to see how affected the patient is by the disease


What is the treatment for acute sarcoidosis

it is a self limiting condition so usually no treatment is administered-but treat the other multisystem involvement


what is given in acute S if a vital organ is affected?



which problem needs steroid treatment and why?

uveitis: because patients can end up with permanent damage


what is the treatment for chronic sarcoidosis ?

This does need treatment oral steroids if vital organ is affected (e.g. lungs, eyes, heart, brain)

they are given prednisolone or steroid sparing drugs


what steroid sparing drugs are given? and what do they do?

immunosuppressants (e.g. azathioprine, methotrexate, anti-TNF therapy)

switches off sarcoidosis effectively