Sarcoidosis: Difference between revisions
Aganapathy (talk | contribs) |
Elcatracho (talk | contribs) |
||
| (5 intermediate revisions by 3 users not shown) | |||
| Line 4: | Line 4: | ||
**Exact cause unknown - thought to be related to an immune reaction to a prior insult such as infection or chemical exposure earlier in life. | **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]]. | **Do not confuse with infectious granulomatous processes such as [[tuberculosis]]. | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC3505767 ad-24-383-g009.png|thumb|Sarcoidosis. (A) Subcutaneous nodules without changes in overlying epidermis. (B) Characteristic non-caseating granuloma with giant cell.]] | |||
[[File:Lupus_pernio.jpg|thumb|Lupus pernio is pathognomonic for sarcoidosis]] | |||
''Depend on location of granulomata. May be entirely asymptomatic.'' | ''Depend on location of granulomata. May be entirely asymptomatic.'' | ||
*Respiratory | *Respiratory | ||
| Line 14: | Line 14: | ||
**[[Cough]] | **[[Cough]] | ||
**[[Pulmonary hypertension]] | **[[Pulmonary hypertension]] | ||
**Pulmonary abscesses/[[empyema]] | **[[lung abscess|Pulmonary abscesses]]/[[empyema]] | ||
**[[Pneumothorax]] | **[[Pneumothorax]] | ||
*Erythema nodosum and other skin lesions | *[[Erythema nodosum]] and other skin lesions | ||
**[[Lupus pernio]] is pathognomonic for sarcoidosis and the most specific physical exam finding<ref>James WD, Berger TG, Elston DM. Macrophage/Monocyte Disorders. In: James WD, Berger TG, Elston DM (eds). Andrews’ Diseases of the Skin, 12e. Philadelphia, PA: Elsevier; 2016, Chapter 31.</ref> | |||
*Fatigue | *Fatigue | ||
*Weight loss | *Weight loss | ||
* | *[[Arthralgia]]s | ||
*Cardiopulmonary | *Cardiopulmonary | ||
**[[Restrictive cardiomyopathy]] | **[[Restrictive cardiomyopathy]] | ||
** | **[[Arrhythmias]] due to conduction disturbance | ||
*Endocrine | *Endocrine | ||
**[[Hypercalcemia]] | **[[Hypercalcemia]] | ||
| Line 28: | Line 29: | ||
**[[Adrenal insufficiency]] | **[[Adrenal insufficiency]] | ||
*Ocular | *Ocular | ||
**Dacryoadenitis (lacrimal duct inflammation) | **[[Dacryoadenitis]] (lacrimal duct inflammation) | ||
**Optic neuritis | **[[Optic neuritis]] | ||
**Iritis | **[[Iritis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 41: | Line 41: | ||
*[[Churg-Strauss syndrome]] | *[[Churg-Strauss syndrome]] | ||
*[[Lupus]] | *[[Lupus]] | ||
*Rheumatoid arthritis | *[[Rheumatoid arthritis]] | ||
*Polymyalgia rheumatica | *[[Polymyalgia rheumatica]] | ||
==Evaluation== | |||
[[File:SarcoidXray.png|thumb|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== | ==Management== | ||
*[[Corticosteroids]] | |||
*Treat complications | |||
==Disposition== | ==Disposition== | ||
*Dependent on presentation | |||
==See Also== | ==See Also== | ||
Latest revision as of 20:25, 1 February 2021
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
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[1]
- Fatigue
- Weight loss
- Arthralgias
- Cardiopulmonary
- Restrictive cardiomyopathy
- Arrhythmias due to conduction disturbance
- Endocrine
- 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
- 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
See Also
External Links
References
- ↑ James WD, Berger TG, Elston DM. Macrophage/Monocyte Disorders. In: James WD, Berger TG, Elston DM (eds). Andrews’ Diseases of the Skin, 12e. Philadelphia, PA: Elsevier; 2016, Chapter 31.