BASICS ABOUT SARCOIDOSIS

1. SARCOIDOSIS
Dr ABHINAND R S
DEPT:OF GENERAL MEDICINE
ESIC MC PGIMSR BANGALOE

2. Multisystem chronic inflammation characterized by
non caseating granulomas.

3. Multisystem chronic inflammation characterized by
non caseating granulomas.
1. BERYLLIOSIS
2. CROHN’S DISEASE
3. HSP(HYPERSENSITIVITY PNEUMONITIS)
4. CAT SCRATCH DISEASE

4. ETIOLOGY
• Disordered immune regulation in genetically predisposed individual
• Triggers may be infectious or non infectious environmental agent.
• Infectious agents-Propionibacter acnes
Mycobacterial protein (M.tuberculosis catalase
peroxidase [mKatG]
• Non infectious-Insecticides and mold

5. HLA SUSCEPTIBILITY
• HLA B8
• DR B1-03
• DR B1-04
• DR B1-02

6. • Women > Men
• 2/3 rd (50-70 %)-Spontaneous Resolution
• 20%- Chronic 5%-Death (mcc- ILD)

7. PATHOGENESIS

8. CLINICAL MANIFESTATIONS
• It can affect any organ system.
Asymptomatic(1/3) --------------------------Organ Failure
• Cough and dyspnea are the most common presenting symptoms.
• Other symptoms related to Ocular and Cutaneous.
• Nonspecific constitutional symptoms –Fatigue(mc),Fever,Night sweats
and weight loss .

9. SKIN
• B/L Hilar adenopathy
• Arthritis
• Erythema nodosum
• +Uveitis in 5% of patients
Lofgren’s Syndrome
• Uveitis
• Parotitis
• B/L LMN 7 th CN palsy
Heerfordt
waldenstorm
syndrome
Acute (Better Prognosis)

10. Extra—Causes for B/L LMN Facial Nerve palsy
• Guillain-Barre syndrome
• Sarcoidosis(Uveoparotid fever)
• Leprosy
• Diabetes mellitus
• Myasthenia gravis
• Lyme’s Disease
• Bulbar palsy

11. Chronic(Bad prognosis)
• Lupus Pernio
• Violaceous papule or Crusted erythematous maculopapular lesion on
face/nose dialated capillaries.

12. SKIN BIOPSY ASTEROID BODY
Stellate eosinophilic

13. EYES
• Chronic Anterior Uveitis( M C)
• Acute Anterior Uveitis
• Retinitis and parsplanitis
• Dry eyes (pre existing lacrimal gland
d’s)
ASYMPTOMATIC
BLINDNESS

14. LUNGS- m c organ affected(>90%)

15. Garland Sign
Lymphadenopathy of Rt & Lft
Hilar,RT paratracheal

16. staging on chest x ray (Scadding scoring system)
• stage I: hilar or mediastinal nodal enlargement only
• stage II: nodal enlargement and parenchymal disease
• stage III: parenchymal disease only
• stage IV: end-stage lung (pulmonary fibrosis)

17. Sarcoidosis involves upper lobe of lungs
others….
• Ankylosing spondylitis
• Psoriatic Arthritis
• Berylliosis
• Radiation Induced Lung Injury
• Hypersensitivity Pneumonitis
• Langerhans cell histiocytosis
• Silicosis
• TB
• Pneumocystis pneumonia

18. • ILD-NSIP
Restrictive pattern in spirometry –Reduced lung volumes
Decreased DLCO
• 50% pts –Obstructive pattern (reduced FeV1/FVC)
• 5% pts-Pulmonary Arterial Hypertension

19. CARDIAC
• Infiltration of the heart muscles by granuloma
CONGESTIVE HEART FAILURE
RESTRICTIVE CARDIOMYOPATHY> DIALATED CARDIOMYOPATY
CONDUCTION DEFECTS % HEART BLOCKS
ARRHYTHMIAS (multifocal) AND SUDDEN CARDIC DEATH
Diag:MRI / PET
Treat:Ablation not effective,ICD systemic therapy can be tried

20. HEPATIC
• INTRAHEPATIC CHOLESTASIS IS POSSIBLE-PORTAL HTN-OTHER
COMPLICATIONS.
RENAL
• CHRONIC TUBULOINTERSTITIAL DISEASE.
• M C GLOMARULAR DISEASE IS –MEMBRANEOUS NEPHROPATHY

21. METABOLIC
• Increased production of 1,25 dihydroxy vit D—increased absorption of
calcium from intestine---HYPERCACEMIA & REDUCED PTH LEVELS
BRAIN (5-10%)
• Cranial nerve involvement—B/l 7TH cranial nerve palsy & Optic neuritis.
• Pituitary stalk & anterior hypothalamus involvement—CENTRAL D I
• Transverse myelitis
• Sizures and cognitive changes.
MRI with g-space occupying lesions,CSF-lymphocytic meningitis with mildly
elevated protein.

22. DIAGNOSIS
• OLD METHOD- Ga 67 scan

23. • NEWER MODALITY—PET SCAN & BIOPSY
• ACE LEVELS NORMAL CAN RULE OUT SARCOIDOSIS
HIGH ACE LEVELS
• Gaucher’s disease
• Miliary TB
• Leprosy(HD)
• Hyperthyroidism

24. • BAL-CD4/CD8—HIGH(> 3.5 times strongly supportive)
• Kviem –Siltzbach procedure—specific diagnostic test for sarcoidosis
I/D injection sarcoid pt’s spleen preparation---Biopsied after 4-6
weeks of injection—non caseating granuloma confirms diag:

25. Treatment
• Acute—organ system inv—systemic steroids
• Chronic—Steroids+mtx/azathioprine/chloroquine
second line:antiTNF alfa -Infliximab