Sarcoidosis: Difference between revisions
No edit summary |
Elcatracho (talk | contribs) |
||
| (8 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Abnormal collection of inflammatory cells ( | *Abnormal collection of inflammatory cells (granulomas) throughout the body. | ||
**Most common location for granulomas to occur are the lung, skin, heart, and brain. | **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. | **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 [[ | **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.'' | |||
*Respiratory | |||
**Due to pulmonary granulomata | |||
**[[Shortness of breath]] | |||
**[[Cough]] | |||
**[[Pulmonary hypertension]] | |||
**[[lung abscess|Pulmonary abscesses]]/[[empyema]] | |||
**[[Pneumothorax]] | |||
*[[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 | ||
* | **[[Restrictive cardiomyopathy]] | ||
* | **[[Arrhythmias]] due to conduction disturbance | ||
* | *Endocrine | ||
* | **[[Hypercalcemia]] | ||
**[[Hypothyroidism]] | |||
**[[Adrenal insufficiency]] | |||
*Ocular | |||
**[[Dacryoadenitis]] (lacrimal duct inflammation) | |||
**[[Optic neuritis]] | |||
**[[Iritis]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Malignancy | *Malignancy | ||
*Tuberculosis | *[[Tuberculosis]] | ||
* | *[[Coccidioidomycosis]] | ||
*Histiocytosis X | *Histiocytosis X | ||
*Wegener's granulomatosis | *[[Wegener's granulomatosis]] | ||
*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.