Sarcoidosis Flashcards
(22 cards)
what is it
multi system granulomatous disorder of unknown cause
epidemiology
age 20-40 years, female more, afro Caribbean more
how often is it found incidentally
in 20-40% on a CXR
what is the finding on CXR
bilateral hilar lymphadenopathy +- pulmonary infiltrates or fibrosis
what are the symptoms in pulmonary disease
dry cough, progressive dyspnoea, decr exercise tolerance, chest pain
what are the non pulmonary haem signs
lymphadenopathy, hepato spleno megaly,
what are the non pulmonary eye signs
uveitis, conjunctivitis, keratoconjunctivitis sicca, glaucoma
what are the non pulmonary ENT signs
enlargement parotid and lacrimal glands, Bells palsy
what are the non pulmonary neuro signs
bells palsy, neuropathy, meningitis, brainstem and spinal syndromes, SOL
what are the non pulmonary derm signs
erythema nodosum, lupus pernio
what are the non pulmonary cardio and homeostatic signs
cardiomyopathy, arrhythmias, hypercalcaemia, hypercalcuria, renal stones, pituitary dysfunction
tests
bloods, 24 urine incr Ca, tuberculin skin test, CXR, ECG, lung function tests, tissue biopsy, bronchoalveolar lavage, US, bone x rays, CT/MRI, opthal assessment
what do the bloods show
incr ESR, lymphopenia, incr LFT, incr ACE, incr Ca, incr Ig
what does tissue biopsy show
of lung, liver, lymph nodes, skin nodules or lacrimal glands is diagnostic and shows NON CASEATING GRANULOMATA
what does BAL show
incr lymphocytes in active disease, incr neutrophils in pulmonary fibrosis
management if just BHL
don’t need treatment as most recover spontaneously
management acute sarcoidosis
bed rest, NSAIDs
management- indications for corticosteroids
parenchymal lung disease, uveitis, hypercalcaemia, neuro or cardiac. pred for 4-6w then decr dose over a year
other therapy in management
if severe- IV methylpred or immunosuppressants, anti TNF, lung transplant
prognosis
60% patients with thoracic resolve over 2y. 20% respond to steroid treatment
differentials of bilat hilar lymphadenopathy
sarcoidosis, infection eg TB, mycoplasma, malignancy eg lymphoma, organic dust disease, extrinsic allergic alveolitis, histiocytosis X
staging of sarcoidosis from the CXR
0-normal. 1- BHL. 2- BHL + peripheral pulmonary infiltrates. 3- peripheral pulmonary infiltrates alone. 4- progressive pulmonary fibrosis, bulla formation (honeycombing), pleural involvement
