SPECIAL SELECTED TOPICS- RESPIRATORY SYSTEM DISORDERS-SSTRSDO-QAA 019
1. Which
organs are most frequently involved in sarcoidosis?
Sarcoidosis is a multisystem granulomatous disease of unknown
etiology. The lungs and hilar lymph nodes are the most commonly affected
organs. Bilateral hilar lymphadenopathy is a characteristic radiological
feature.
The skin is frequently involved, producing erythema nodosum
or lupus pernio. Ocular involvement includes uveitis, conjunctivitis, and
lacrimal gland enlargement.
Peripheral lymph nodes, liver, and spleen are commonly
affected. Cardiac sarcoidosis may cause arrhythmias and heart failure.
Neurosarcoidosis involves the cranial nerves, meninges, or brain. Hypercalcemia
may occur because activated macrophages produce excess vitamin D.
Although almost any organ may be involved, pulmonary disease
predominates.
2. How is
the diagnosis of sarcoidosis established?
The diagnosis of sarcoidosis is based on clinical,
radiological, and histopathological findings while excluding other
granulomatous diseases. Chest radiography and CT scan commonly demonstrate
bilateral hilar lymphadenopathy and interstitial lung infiltrates. Tissue
biopsy reveals non-caseating epithelioid granulomas without central necrosis.
Special stains and cultures exclude tuberculosis and fungal infections.
Bronchoalveolar lavage often shows increased CD4-positive T
lymphocytes. Serum angiotensin-converting enzyme (ACE) levels may be elevated
but are not specific. Hypercalcemia and hypercalciuria support the diagnosis in
some patients.
Pulmonary function tests usually show a restrictive pattern.
A combination of compatible clinical features and biopsy-confirmed
non-caseating granulomas establishes the diagnosis.
3.
Discuss the most frequent clinical symptoms in patients with sarcoidosis.
Many patients with sarcoidosis are asymptomatic and are
diagnosed incidentally on chest radiography. Symptomatic patients commonly
present with persistent dry cough and progressive exertional dyspnea. Fatigue,
fever, weight loss, and malaise are frequent constitutional symptoms.
Chest discomfort may occur because of pulmonary involvement.
Skin lesions such as erythema nodosum are common. Ocular manifestations include
blurred vision, eye pain, and photophobia due to uveitis.
Peripheral lymphadenopathy may be present. Cardiac
involvement may cause palpitations or syncope. Neurological symptoms occur in
patients with neurosarcoidosis. Clinical manifestations vary according to the
organs involved.
4. What
is the clinical course of sarcoidosis?
The clinical course of sarcoidosis is highly variable. Many
patients undergo spontaneous remission within two to five years. Others develop
chronic persistent disease with progressive pulmonary fibrosis. Pulmonary
function gradually declines in patients with extensive lung involvement.
Relapses may occur after apparent recovery. Corticosteroids
are the main treatment for symptomatic or progressive disease.
Immunosuppressive agents are used in steroid-resistant cases.
Cardiac or neurological sarcoidosis may be life-threatening.
Advanced pulmonary fibrosis can lead to pulmonary hypertension and respiratory
failure. Overall prognosis is generally favorable, particularly in patients
with isolated hilar lymphadenopathy.
PROFESSOR OF MEDICINE
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