🎯 Pathology

• a disorder of unknown cause that causes the immune system to overreact to form non-caseating granulomas in different organs

• a granuloma is an area of inflammation formed by white blood cells that have been “walled off” or separated from the rest of the body by fibrous tissue

• granulomas can be found anywhere in the body, but are most commonly found in the lungs

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💡 Causes

• unknown

• but it is more common in Afro-Caribbeans and middle-aged adults

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🩺 Clinical features

• S: Skin lesions (Erythema nodosum or Lupus pernio)

• A: Bilateral hilar Adenopathy

• R: Restrictive lung disease

• C: Cough (non-productive), Chest pain

• O: Ocular manifestations (Uveitis)

• I: Interstitial lung disease

• D: Elevated 1,25-Dihydroxyvitamin D (Hypercalcemia)

• O: Non-caseating granulOmas in tissues

• S: Systemic symptoms (Fever, Fatigue)

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😢 Syndromes associated with sarcoidosis

• Lofgren’s syndrome

  • fever + erythema nodosum + arthralgia + bilateral hilar adenopathy

• Heerfordt’s syndrome

  • facial nerve paralysis + anterior uveitis + enlargement of the parotid or salivary glands

• Mikulicz syndrome

  • enlargement of the parotid and lacrimal glands

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🕵️‍♂️ Investigations

• bloods

  • hypercalcaemia, raised ACE, CD4/CD8 ratio, CRP and ESR

• spirometry

  • restrictive pattern

• DLCO

  • reduced

• chest x-ray

  • if chest x-ray is clear —> perform high-resolution CT scan

• MRI or PET scan

  • for cardiac or CNS-affected sarcoidosis

• biopsy of lymph nodes

  • non-caseating granulomas

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💆‍♂️ Management​

• majority undergo spontaneous remission

• if symptoms worsen, corticosteroids are considered​

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😢 Complications​

• sarcoidosis is a type of restrictive lung disease, which lead to pulmonary hypertension

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