Sarcoidosis: Difference between revisions

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==Background==
==Background==
Sarcoidosis is the abnormal collection of inflammatory cells called [[grandulomas]] throughout the body. The most common location for these granulomas to occur are the lung, skin, heart, and brain. The exact cause of sarcoidosis is not known, however it is thought to be related to an immune reaction to a prior insult such as infection or chemical exposure earlier in life. This is not to be confused with a infectious granulomatous processes such as [[pulmonary tuberculosis]].
*Abnormal collection of inflammatory cells (granulomas) throughout the body.
[[File:SarcoidXray.png|thumb|Sarcoid Xray - hilar adenopathy]]
**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==
==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
*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
*[[Tuberculosis]]
*[[Coccidioidomycosis]]
*Histiocytosis X
*[[Wegener's granulomatosis]]
*[[Churg-Strauss syndrome]]
*[[Lupus]]
*[[Rheumatoid arthritis]]
*[[Polymyalgia rheumatica]]


==Workup==
==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==


==External Links==
==External Links==


==References==
==References==

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

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.

Differential Diagnosis

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

Disposition

  • Dependent on presentation

See Also

External Links

References

  1. 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.