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Sarcoidosis (Treatment (Do NOT treat symptomatic patients at Stage 2 or 3,…
Sarcoidosis
Treatment
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Acute sarcoidosis - bed rest, NSAIDs
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Corticosteroids - prednisolone orally then gradually reduce dose, in severe illness give IV methylprednisolone
Patients with bilateral hilarity lymphadenopathy DON'T NEED TREATMENT since most will recover spontaneously
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Diagnosis
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Lung function tests - may be normal or show reduced lung volumes, impaired gas transfer and a restrictive ventilatory defect
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Tissue biopsy - DIAGNOSTIC, shows non-caveating granulomata
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Bronchoalveolar lavage (BAL) - shows increased lymphocytes in active disease, increased neutrophils if pulmonary fibrosis present
CXR - used for staging
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Stage 4 - Progressive pulmonary fibrosis, bulla formation & bronchiectasis
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Epidemiology
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African-Caribbeans are affected more frequently and more severely than Caucasians - particularly by extra-thoracic disease
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Clinical Presentation
Constitutional symptoms - fever, weight loss and fatigue
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Respiratory symptoms
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90% have abnormal CXRs with bilateral hilar lymphadenopathy with/without pulmonary infiltrates/fibrosis
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Other symptoms
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Facial numbness, dysphagia & visual field defects
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Lupus pernio - blue/red nodules and plaques over nose, cheek and ears
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In 20-40% the disease is discovered incidentally, after a routine CXR and is thus asymptomatic
Key Facts
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Affects any organ system, but commonly involves the mediastinal lymph nodes and lung
Type of Interstitial Lung Disease - distinct cellular infiltrates and extracellular matrix deposition in lung distal to the terminal bronchiole
Typically presents with bilateral hilarity lymphadenopathy, pulmonary infiltration and skin or eye lesions
Pathophysiology
Typically sarcoid granulomas consist of focal accumulations of epitheloid cells, macrophages and lymphocytes - mainly T cells
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Differential Diagnosis
Rheumatoid arthritis, lymphoma, metastatic malignancy, TB, lung cancer, SLE, idiopathic pulmonary fibrosis & multiple myeloma