Sarcoidosis

Background

• Abnormal collection of inflammatory cells (granulomas) throughout the body.
  • Most common location for granulomas to occur are the lung, skin, heart, and brain.
  • Exact cause unknown - thought to be related to an immune reaction to a prior insult such as infection or chemical exposure earlier in life.
  • Do not confuse with infectious granulomatous processes such as tuberculosis.

Clinical Features

Sarcoidosis. (A) Subcutaneous nodules without changes in overlying epidermis. (B) Characteristic non-caseating granuloma with giant cell.

Lupus pernio is pathognomonic for sarcoidosis

Depend on location of granulomata. May be entirely asymptomatic.

• Respiratory
  • Due to pulmonary granulomata
  • Shortness of breath
  • Cough
  • Pulmonary hypertension
  • Pulmonary abscesses/empyema
  • Pneumothorax
• Erythema nodosum and other skin lesions
  • Lupus pernio is pathognomonic for sarcoidosis and the most specific physical exam finding
• Fatigue
• Weight loss
• Arthralgias
• Cardiopulmonary
  • Restrictive cardiomyopathy
  • Arrhythmias due to conduction disturbance
• Endocrine
  • Hypercalcemia
  • Hypothyroidism
  • Adrenal insufficiency
• Ocular
  • Dacryoadenitis (lacrimal duct inflammation)
  • Optic neuritis
  • Iritis

Differential Diagnosis

• Malignancy
• Tuberculosis
• Coccidioidomycosis
• Histiocytosis X
• Wegener's granulomatosis
• Churg-Strauss syndrome
• Lupus
• Rheumatoid arthritis
• Polymyalgia rheumatica

Evaluation

Sarcoid Xray - hilar adenopathy

• Definitive initial diagnosis unlikely to be made in ED, but may be suggested by typical granulomatous lesions seen on CT or other imaging in setting of appropriate clinical context
• Evaluate for complications/alternative diagnoses of presenting symptoms

Management

• Corticosteroids
• Treat complications

Disposition

• Dependent on presentation