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Sarcoidosis

Feb 09, 20242 min read

  • Chronic granulomatous disorder.
  • Granulomas are inflammatory nodules full of macrophages
  • Unknown cause
  • Mainly respiratory but all organs affected

Hypercalcaemia + bilateral hilar lymphadenopathy ?sarcoidosis

Causes/Factors

  • Aged 20-40 or around 60
  • Women
  • Black ethnic origin

Tip

The typical MCQ exam patient is a 20-40 year old black female presenting with a dry cough and shortness of breath. They may have nodules on their shins, suggesting erythema nodosum.

Issues per organ

Lungs

Systemic

  • Fever
  • Fatigue
  • Weight loss

Liver

Eyes

Heart

Kidneys

Others but more non specific

Lofgren’s Syndrome

Refers to a specific presentation of sarcoidosis with a classic triad of symptoms:

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

Differentials

The top differentials for the varied presenting features of sarcoidosis are:

Investigations

The blood test findings to remember are:

  • Raised angiotensin-converting enzyme (ACE) (often used as a screening test)
  • Raised calcium (hypercalcaemia)
  • U&Es for kidney involvement
  • Urine albumin-creatinine ratio to look for proteinuria
  • LFTs for liver involvement

Imaging

  • Chest x-ray may show hilar lymphadenopathy
  • High-resolution CT scanning may show hilar lymphadenopathy and pulmonary nodules
  • MRI can show central nervous system involvement
  • PET scan can show active inflammation in affected areas

Management

Conservative management is considered in patients with no or mild symptoms.

Oral steroids (for 6-24 months) are usually first-line where treatment is required. Bisphosphonates protect against osteoporosis whilst on long-term steroids.

Methotrexate is a second-line option.

Lung transplant is rarely required in severe pulmonary disease.

Complications/red Flags

Spontaneously resolves in 50% of patients. Overall mortality of less than 10%

Graph View

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