Sarcoidosis. This post will cover the points you need to know for your board exams as well as for teaching residents on the daily rounds. Please don't use the information here to treat your patients.
Multisystem noncaseating inflammatory disease that is more common in black females affecting mainly lungs, lymph nodes, skin and eyes. General symptoms include fever, weight loss, malaise and night sweats. In pulmonary involvement (>90% of patients), there will be cough and dyspnea. In eye involvement there will be photosensitivity and pain. In skin involvement, there will be erythema nodosum.
Lupus pernio is violaceous skin eruption of the central face in sarcoidosis patients.
Löfgren syndrome due to acute sarcoidosis with fever, erythema nodosum, bilateral hilar lymphadenopathy, and ankle arthritis.
Heerfordt-Waldenström syndrome (uveoparotid fever in sarcoidosis) characterized by fever, anterior uveitis, bilateral lacrimal and parotid gland enlargement.
Sicca syndrome manifested by dry eyes and mouth.
Sarcoidosis may lead to increased production of vitamin 1,25 dihydroxy D3 and hence low PTH and hypercalcemia leading to nephrocalcinosis, renal stones and failure.
ACE level (usually elevated) doesn't help, tissue biopsy is diagnostic instead.
Always do an eye slit lamp and fundus examination.
Treat only symptomatic disease. Treat with steroids. If refractory, then use immunosuppressant and antimalarial medications. These include methotrexate, azathioprine (Imuran), Leflunomide (Arava), hydroxychloroquine (Plaquenil), Infliximab (Remicade) and Adalimumab (Humira). Follow the guidelines for these medication before starting them as liver testing and tuberculosis screening.
For further reading on sarcoidosis this full coverage book by Donald Mitchell.
The information in this post is not for patients and shouldn't be used in treating patients. Please refer to your doctor for medical advice.