Sarcoidosis

Question 1

What is sarcoidosis?

Answer 1

Granulomatous inflammatory condition
Granulomas are nodules of inflammation full of macrophages

Usually associated with chest symptoms but also has multiple extra-pulmonary manifestations such as erythema nodosum and lymphadenopathy

Spikes in young adults and around 60

Question 2

Lung symptoms in Sarcoid

Answer 2

Mediastinal lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules

Question 3

Systemic symptoms in Sarcoid

Answer 3

Fever
Fatigue
Weight loss

Question 4

Liver symptoms in sarcoid

Answer 4

Liver nodules
Cirrhosis
Cholestasis

Question 5

Eye symptoms

Answer 5

Uveitis
Conjunctivitis
Optic neuritis

Question 6

Skin symptoms in sarcoid

Answer 6

Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat)
Lupus pernio (raised, purple skin lesions commonly on cheeks and nose)
Granulomas develop in scar tissue

Question 7

Heart symptoms

Answer 7

Bundle branch block
Heart block
Myocardial muscle involvement

Question 8

Kidney symptoms

Answer 8

Kidney stones (due to hypercalcaemia)
Nephrocalcinosis
Interstitial nephritis

Question 9

CNS Symptoms

Answer 9

Nodules
Pituitary involvement (diabetes insipidus)
Encephalopathy

Question 10

PNS Symptoms

Answer 10

Facial nerve palsy

Mononeuritis multiplex

Question 11

Bone symtoms

Answer 11

Arthralgia
Arthritis
Myopathy

Question 12

What is Lofgren’s Syndrome?

Answer 12

Specific presentation of sarcoidosis. It is characteristic by a triad of:

Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia (joint pain in multiple joints)

Question 13

Differential diagnosis for sarcoid

Answer 13

Tuberculosis
Lymphoma
Hypersensitivity pneumonitis
HIV
Toxoplasmosis
Histoplasmosis

Question 14

Blood tests in sarcoid

Answer 14

Raised serum ACE. This is often used as a screening test.
Hypercalcaemia (rasied calcium) is a key finding.
Raised serum soluble interleukin-2 receptor
Raised CRP
Raised immunoglobulins

Question 15

Imaging in sarcoid

Answer 15

Chest xray shows hilar lymphadenopathy
High-resolution CT thorax shows hilar lymphadenopathy and pulmonary nodules
MRI can show CNS involvement
PET scan can show active inflammation in affected areas

Question 16

Gold standard for confirming sarcoid?

Answer 16

Histology from biopsy, usually from bronchoscopy with US guided biopsy of mediastinal lymph nodes

Shows characteristic non-caseating granulomas with epithelioid cells

Question 17

Test for other organ involvement in sarcoid (6)

Answer 17

U&Es for kidney involvement
Urine dipstick or urine albumin-creatinine ratio to look for proteinuria indicating nephritis
LFTs for liver involvement
Ophthalmology review for eye involvement
ECG and echocardiogram for heart involvement
Ultrasound abdomen for liver and kidney involvement

Question 18

Treatment for sarcoid

Answer 18

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

Oral steroids are usually first line where treatment is required
Given for between 6 and 24 months (bisphosphonates)

Second line options are methotrexate or azathioprine

Lung transplant is rarely required in severe pulmonary disease

Question 19

What is the prognosis for sarcoidosis?

Answer 19

spontaneously resolves within 6 months in around 60% of patients

Small number of patients it progresses with pulmonary fibrosis and pulmonary hypertension (lung transplant)

Death is usually due to heart or CNS involvement