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Flashcards in Sarcoidosis Deck (6)
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Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is more common in young adults and in people of African descent.

What are the clinical features of sarcoidosis?

  • Acute → erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
  • Insidious → dyspnoea, non-productive cough, malaise, weight loss
  • Skin → lupus pernio
  • Hypercalcaemia → macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol) 

Two spikes in incidence, in young adulthood and again around age 60. Typical MCQ exam patient is 20-40 y/o black woman presenting w/ dry cough and SoB. They may have nodules ontheir shins suggesting erythema nodosum.


What are symptoms affecting each particular system for sarcoidosis?

  • Lungs → mediastinal lymphadenopathy, pulm fibrosis + nodules
  • Systemic → fever, fatigue, weight loss
  • Liver → liver nodules, cirrhosis, cholestasis
  • Eyes → uveitis, conjunctivitis, optic neuritis
  • Skin → erythema nodosum, lupus pernio, granulomas
  • Heart → bundle branch block, heart block, myocardial muscle involvement
  • Kidneys → kidneys, nephrocalcinosis, interstitial nephritis
  • CNS → nodules, pituitary involvement, encephalopathy
  • PNS → facial nerve palsy, mononeuritis multiplex
  • Bones → arthralgia, arthritis, myopathy

These are in order of most common to least common (top to bottom)


What is Lofgren's syndrome?

There is a specific presentation of sarcoidosis, triad:

  • Erythema nodosum
  • Bilateral hilar lymphadenopathy
  • Polyarthralgia 


How is sarcoidosis investigated?

  • diagnosis largely clinical
  • ACE levels 60% sensitivity + 70% specificity
    • not reliable in diagnosis but role in monitoring
  • routine bloods may show hypercalcaemia + raised ESR
  • CXR may show:
    • stage 0 = normal
    • stage 1 = bilateral hilar lymphadenopathy
    • stage 2 = BHL + interstitial infiltrates
    • stage 3 = diffuse interstitial infiltrates only
    • stage 4 = diffuse fibrosis 
  • spirometry may show restrictive defect
  • tissue biopsy shows non-caseating granulomas


What is the gold standard for confirming diagnosis of sarcoidosis?

  • Histology from biopsy
  • Done by bronchoscopy w/ USS guided biopsy of mediastinal lymph nodes
  • Histology shows non-caseating granulomas + epithelioid cells


No treatment is considered as first line in patients with no or mild symptoms as the condition often resolves spontaneously.

What is the management of sarcoidosis?

Steroids indicated if:

  • Pts w/ CXR stage 2 or 3 disease who have moderate-severe or progressive symptoms. Pts w/ asymptomatic + stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment
  • Hypercalcaemia
  • Eye, heart or neuro involvement

Give bisphosphonates for bone protection too. Second line includes methotrexate and azathioprine. Lung transplant in severe disease.