Intern Report 1/19: Sarcoidosis

Teaching Pearls:

  • Presents in 20-60 year old individuals. Diagnosis tends to occur 10 years earlier in blacks than Caucasians.
  • Over 90% present with pulmonary findings on imaging.
  • About 50% of patients with sarcoidosis are asymptomatic.
  • About 30% of patients with sarcoidosis have extrapulmonary manifestations
  • Extrapulmonary manifestations include:
    • Cutaneous – can be found on tattooed skin
    • Cardiac – monitor for conduction delays, infiltrative heart diseases
    • Lymph nodes, liver, spleen
    • GI
    • Renal
    • Systemic symptoms
  • Differential Diagnosis
    • Infectious
      • HIV, TB, fungal lung diseases
    • Occupational/environmental toxin exposure
    • Hypersensitivity pneumonitis
    • Pneumoconiosis (Beryllium)
    • Langerhans Cell histiocytosis
    • Malignancy (lymphoma)
  • Diagnosis is made with the following:
    • Clinical and radiographic findings
    • Excluding other potential causes
    • Tissue biopsy
  • Lofgren’s syndrome
    • Erythema nodosum, bilateral hilar adenopathy, fever, arthritis
    • Biopsy not needed if Lofgren’s syndrome is present (high specificity)
    • Prognosis – fantastic; treatment – NSAIDs
    • A Boards favorite topic. (Very high yield)

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