10.7.09

10.17.09

Sarcoidosismorning report 12.21.09

Alisa Alker

Sarcoidosis

multisystem granulomatous disorder of unkown etiology

prevalence: ~ 20 per 100,000

more common in Blacks and Scandinavians

usually presents between ages 10-40

Clinical presentation

Sarcoidosis can affect many organs but 90% have lung involvement

typically presents with cough, dyspnea, fatigue, fever, weight loss

RadiologyStage I - bilateral hilar adenopathy

stage 2 - bilateral hilar adenopathy + reticular opacities

stage 3- reticular opacities with shrinking hilar nodes

stage 4- reticular opacities with evidence of volume loss. conglomerated masses with bronchiectasis or cavitation may be seen

More radiology

up to 40% have parenchymal involvement such as interstitial inflitrates, fibrotic appearing infiltrates

usually more pronounced in the upper airways and often asymmetric

Extrapulmonarymost common organs affected: Skin, lymph nodes, eye, liver

skin: erythema nodosom, macupapular eruption,

eye: anterior or posterior uveitis

liver: hepatomegally with or without granulomas

Diagnosis

compatible clinical and radiographic manifestations

exclusion of other diseases that may present similarly (histo, TB, berylliosis, eosinophilic granuloma, hypersensitivity pneumonitis

histopathology demonstrating noncaseating granulomas

Treatment/prognosis

systemic corticosteroids or cytotoxic agents (azathioprine or methotrexate)

many patients are asymptomatic

60% of patients have spontaneous resolution

mortality rate is 1-6%

smoking & sarcoidosisIs there a relationship between smoking and sarcoidosis?

Douglas 1986: people diagnosed with sarcoidosis (n=202) had a lower prevalence of smoking that the general public (22 vs 43%)

Valeyre 1988: case control study (n=131) no association between smoking and the occurence or severity of sarcoidosis

References

Dempsey OJ, Paterson EW, Kerr KM, Denison AR. Sarcoidosis. BMJ. 2009;339:b3206.

Douglas JG, Middleton WG, Gaddie J, Petrie GR, Choo-Kang YF, Prescott RJ, et al. Sarcoidosis: a disorder commoner in non-smokers? Thorax. 1986 Oct;41(10):787-791.

Polychronopoulos VS, Prakash UBS. Airway involvement in sarcoidosis. Chest. 2009 Nov;136(5):1371-1380.

Talmadge K. Clinical manifestations and diagnosis of sarcoidosis. UpToDate. 2009 Oct 1;

Valeyre D, Soler P, Clerici C, Pre J, JP Battesti, Georges R, et al. Smoking and pulmonary sarcoidosis: effect of cigarette smoking on prevalence, clinical manifestations, alveolitis, and evolution of disease. Thorax. 1988;43:516-524.

Happy Holidays