Sarcoidosi S: DR Avishek Naskar Asst Prof, Dept of Medicine, Esi Pgimsr, Joka

SARCOIDOSI
Dr Avishek Naskar
Asst prof, dept of Medicine,
ESI PGIMSR, Joka
WHAT IS IT
 Sarcoidosis is a multisystem inflammatory disease of
unknown etiology that manifest as non-caseating
granulomas, predominantly in the lungs and intrathoracic
lymph nodes.
 Incidence is 5 – 40 cases per 100,000 population, mostly
in white populations, also in people of African origin.
 Sarcoidosis is misdiagnosed as TB in developing
countries like ours.
PATHOPHYSIOLOGY
 There is no clear understanding of the whole
pathogenesis of sarcoidosis, but it is definitely known,
that CD4 T cells play a central role, and you will see that
they (CD4 T cells) are found abundantly, in tissues.
Pathogensis of Sarcoidosis. γ-IFN mainly stimulates granuloma formation. If
there is persistent action of the cytokine IL-8, then the disease progesses to
chronicity (fibrosis)
CLINICAL FEATURES
 Asymptomatic - 5% cases.
 Systemic complains (e.g. fever, weight loss, arthralgia,
night sweats) – 45%
 Individual organs clinically…..
1)Lungs :
 Cough & dyspnoea clinically
 On investigations,
 Hilar lymphadenopathy
 Fibrosis : mostly upper lobes
 Pulmonary arterial hypertension (5%)

CHECK MEDIASTINAL WIDENING (DUE
TO HILAR LYMPHADENOPATHY)
See the predominant upper lobar opacities on both sides, from fibrosis in
Sarcoidosis. This may be seen in TB also, which is more common in India
and other developing countries. But the tests for TB will come negative e.g.
sputum for AFB.
CLINICALLY….
2)Skin
 Most common – maculopapular rash
 Others – erythema nodosum, subcutaneous nodules
 Lupus pernio – indurated lesions in cheeks, bridge of nose and

under eyes
3)Liver
 Most common – asymptomatic raised alkaline phosphatase
 Hepatomegaly
 Less common – extensive intrahepatic cholestasis, leading to

portal hypertension
LUPUS PERNIO : SEE THE INDURATIONS
CLINICAL FEATURES CONTD…
4)Eyes
 Anterior uveitis – painful eyes with redness,
photophobia, blurred vision, watering.
 Dry eyes (sicca)
5) Spleen & bone marrow

 Splenomegaly
 Anemia, lymphopenia
6)Bones
 Hypercalcemia – due to increased activity of 1α-
hydroxylase (Vit D activation increased)
7)Nervous system (5 – 10%)

 Cranial nerve affected – CN VII (facial)palsy, optic
neuritis (chronic progression)
 CNS – anterior hypothalamus affected causing diabetes
insipidus; basilar meningitis
8)Renal :
Granulomas in kidney and hypercalcemia, both may cause
renal impairment
9)Cardiac
 Life threatening arrythmias – ventricular tachycardia, AV
nodal blocks
 CHF (<10% cases)
CLINICALLY…
 Lofgren’s syndrome : an acute form of Sarcoidosis with
erythema nodosum, hilar lymphadenopathy and uveitis.
Has good prognosis.
DIAGNOSIS
DIAGNOSIS CONTD…
 The previous slide shows an algorithm for diagnosis of
Sarcoidosis
 Classical syndrome means : An young or middle aged
lady with common clinical features , like erythema
nodosum, B/L hilar lymphadenopathy, uveitis,
hypercalcemia (on serum calcium level testing).
 You should know the differences between TB and
sarcoidosis. TB is far common in India.
SARCOIDOSIS VS TB
TB can present in numerous forms in India, but subtle differences exist
with Sarcoidosis . Obviously, you should know TB better, but sarcoidosis
for theory too.
Any granuloma : Histiocytes fuse to form multinucleate giant cells,
epitheloid macrophages, lymphocytes, fibroblasts, with fibrosis. Difference
is the presence of caseation necrosis in centre of TB granuloma and its
absence in sarcoidosis.
TREATMENT
 Treatment is mainly given for organ threatening disease
e.g. Uveitis/optic neuritis (may lead to blindness),
hypercalcemia, neurological manifestations.
 But usually minor manifestations e.g. erythema nodosum
need no treatment or just symptomatic treatment.
 For advanced lung fibrosis  lung transplant
TREATMENT : ACUTE DISEASE
TREATMENT : CHRONIC SARCOIDOSIS
Thank you

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SARCOIDOSI

 Fibrosis : mostly upper lobes

 Pulmonary arterial hypertension (5%)

 Others – erythema nodosum, subcutaneous nodules

 Lupus pernio – indurated lesions in cheeks, bridge of nose and

 Less common – extensive intrahepatic cholestasis, leading to

5) Spleen & bone marrow

7)Nervous system (5 – 10%)

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