Sarcoidosis Cheat Sheet

Sarcoidosistypicallypresentsinpatientsbetween20and60yearsofage;diseaseonsetisapproximately10
yearsearlierinblacksthaninwhites.Inapproximatelyonehalf,thediseaseisdetectedincidentallyby
radiographicabnormalities.Theotherhalf.commonpresentingrespiratorysymptomsincludecough,
dyspnea,andchestpain;thesearefrequentlyaccompaniedbyfatigue,malaise,fever,andweightloss.
Diagnosis
Adefinitivediagnostictestdoesnotexist.Instead,thediagnosisofsarcoidosisrequiresthreeelements:
Compatibleclinicalandradiographicmanifestations
Exclusionofotherdiseasesthatmaypresentsimilarly
Histopathologicdetectionofnoncaseatinggranulomas.
*bilateralhilaradenopathyinanasymptomaticpatientdoesnotneedaconfirmatorybiopsy
**LofgrensSyndromedoesnotneedabiopsy.Its95%specific.(seep.2formore)
***Donotbiopsyerythemanodosum,becauseyouwontseegranulomas.
Manifestations
Upto30%haveextrapulmonarymanifestations.Themostcommonmanifestationsare:
Lungs
95.0%involvement
Skin(Excludingerythemanodosumseebelow) 15.9
Lymphnode
15.2
Eye
11.8
Liver
11.5
Erythemanodosum
8.3
Spleen
6.7
Neurologic
4.6
Parotid/salivary
3.9
Bonemarrow
3.9
Calcium
3.7
ENT
3.0
Cardiac
2.3
Renal
0.7
Bone/joint
0.5
Muscle
0.4
Skin:Mostcommonextrapulmonarymanifestation.Examplesofspecificskinmanifestationsof
sarcoidosisincludepapules,nodules,plaques,andatrophicorulcerativelesions.
Eyes:Allpatientswithsuspectedsarcoidosisshouldundergoophthalmologicexamination.Sarcoidosiscan
causeanterior,intermediate,andposterioruveitis,aswellasretinalperiphlebitis.Extraocularinvolvement
canaffectthelacrimalglands,conjunctiva,andocularmuscles.
CardiacTheinitialevaluationofallpatientswithsarcoidosisshouldincludeanelectrocardiogram.The
rangeofsarcoidinvolvementoftheheartincludesheartblockandarrhythmias(duetoinvolvementofthe
conductingsystem),heartfailure,valvulardysfunction,andpericardialdisease.Oritcanbecompletely
benign.
Jointssymmetricinvolvementoftheanklejoints,butmayinvolveotherjoints.Acharacteristicfeatureis
thattheswellingusuallyoccursinthesofttissuearoundjoints,causingaperiarthritisratherthanatrue
arthritis.

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Sarcoidosis Cheat Sheet

Lofgrensyndrome(LS)isthecombinationoferythemanodosum(EN),hilaradenopathy,migratory
polyarthralgia,andfever.ThepresenceofallfeaturesofLShas95percentspecificityforsarcoidosis.
However,erythemanodosumwithouttheotherfeatureshasabroaddifferential.
Painlessswellingofthesalivaryandparotidglandsoccursinapproximately5percentofpatientswith
sarcoidosis.
Abnormalitiesrelatedtocalciummetabolismarethemostcommonrenalandelectrolyteabnormalities
observedamongpatientswithsarcoidosis.Abnormalcalciummetabolismcanresultinnephrocalcinosis
andnephrolithiasis.Otherrelativelycommonrenalcomplicationsofsarcoidosisincludeinterstitial
nephritisandmembranousnephropathy.
Neurologiccanbethepresentingfeature.Commonsyndromesincludecranialmononeuropathy,
neuroendocrinedysfunction,afocalormultifocalencephalopathy,myelopathy,hydrocephalus,aseptic
meningitis,peripheralneuropathy.
Endocrinemanifestationsofsarcoidosisincludehypothalamicinvolvement(duetobasilargranulomatous
meningitisnotedabove)andinfiltrationofthethyroid.
Extrapulmonarymanifestationsvaryonthebasisofsex,ageatpresentation,andethnicity.Seebelow

Treatment:
Donottreatasymptomaticsarcoidosis.Glucocorticoidsaretypical1stlinetreatmentineachorgansystem.
Examplesgivenbelow
Pulmonarymanifestationsaretreatedwithoralandinhaledglucocorticoids.
Anterioruveitisinsarcoidosisrespondsnicelytotopicalglucocorticoidtherapyalone.

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Sarcoidosis Cheat Sheet

SkinManifestationsrespondtotopicalglucocorticoids.
Hypercalcemiainsarcoidosis.TxiswithPrednisone,ifrefractorythen,ketoconazole,infliximabor
bisphosphonates.Medicaltherapyisinadditiontoreducingcalciumintake(nomorethan400mg/day),
reducingoxalateintake,eliminationofdietaryvitaminDsupplements,andavoidanceofsunexposure.
CardiacSarcoidosis.Tx1stLineisglucocorticoids.Secondlineischloroquine,hydroxychloroquine,
cyclosporine,andmethotrexateforpatientswhodonotrespondtoglucocorticoids.PacemakingorICD
(implantablecoronarydefibrillator),and/orablationisusedinthepresenceofVentricularTachycardia.

WhattestsdoyouPerforminSomeonewithSarcoidosis?

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Sarcoidosis Cheat Sheet

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