It is asymptomatic in up to 40% of cases, being discovered incidentally on a routine CXR.
Features of sarcoidosis may be divided into pulmonary and non-pulmonary:
Pulmonary features of sarcoidosis:
- dry cough
- progressive dyspnoea
- chest pain
Non-pulmonary features of sarcoidosis include:
- lymphadenopathy (commonest in non-whites)
- erythema nodosum (commonest in white females)
- polyarthralgia
- hepatomegaly
- splenomegaly (around 25%)
- anterior uveitis (around 25%)
- glaucoma
- Bells palsy
- lupus pernio
- hypercalcaemia
- renal stones
- pituitary dysfunction
- cardiomyopathy...
90% of patients with sarcoid will have an abnormal CXR.
Staging of CXR in sarcoid is:
- 0 = clear CXR
- 1 = bilateral hilar lymphadenopathy
- 2 = bilateral hilar lymphadenopathy plus pulmonary infiltration
- 3 = pulmonary infiltration only
- 4 = fibrosis, honeycombing, pleural involvement
Investigations:
- raised ESR
- lymphopenia
- raised LFTs
- raised serum ACE
- raised calcium (5%)
- tuberculin skin test is positive in around a third
Management:
- BHL alone doesn't need treatment
- acute sarcoidosis : NSAIDs and bed rest
- prednisolone ( 40mg OD for 4-6 weeks then reducing dose over one year) is indicated if:
- parachymal lung disease
- uveitis
- hypercalcaemia
- neurological/cardiac involvement
Lets move on to briefly consider lofgrens syndrome...
