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Sarcoidosis

Sarcoidosis is a multi-system, non-caseating granulomatous inflammatory condition. Granulomas are nodules of inflammation, and are full of macrophages. There are 2 types of granulomas:

  • Caseating (necrotic centre) – Associated with infection

  • Non-caseating (no necrotic centre) – Associated with inflammation

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Signs and symptoms of sarcoidosis - National Heart, Lung, and Blood Institute

A typical patient here is a 20-40 year old black women presenting with a dry cough and SOB, and may have erythema nodosum.


Patients usually present with pulmonary symptoms, and multiple extra-pulmonary manifestations, such as erythema nodosum and lymphadenopathy.


Lofgren’s Syndrome - Acute Sarcoidosis - Presents with a triad of bilateral hilar lymphadenopathy, polyarthralgia, and erythema nodosum.


Affected Organs

  • Lungs (>90%) – Mediastinal lymphadenopathy, Pulmonary fibrosis, Granulomas

  • Liver – Granulomas, Cirrhosis, Cholestasis

  • Eyes – Uveitis, Conjunctivitis, Optic neuritis

  • Skin – Erythema nodosum, Lupus pernio (raised, purple lesions on cheeks and nose), Granulomas on scar tissue

  • Heart – BBB, Heart block, Myocardial muscle involvement

  • Kidneys – Stones, Nephrocalcinosis (calcium deposition), Interstitial nephritis


Investigations

Diagnosed with a tissue biopsy, which will show non-caseating granulomas.


Investigations to do include:

  • Bloods - Raised ESR, Raised ACE, Hypercalcaemia

  • Imaging - CXR, CT Chest, PET (shows active inflammation in affected areas)

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An AP chest X-ray of a 45 year old man with verified sarcoidosis - Mikael Häggström

Management

No treatment required if bilateral hilar lymphadenopathy alone as it usually resolves spontaneously within 6 months for most patients.


Acute Sarcoidosis:

  • 1st line - Rest, NSAIDs, Steroids (for 6-24 months)

    • Patients should be co-prescribed bisphosphonates for bone protection

  • 2nd line - Immunosuppressants e.g. Methotrexate or Azathioprine




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