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SARCOIDOSIS

SARCOIDOSIS. Idiopathic multisystem disorder Characterised by non-caseating granulomata More common in women 20-50 yrs More common in blacks and Asians ? Related to mycobacteria. SARCOIDOSIS Systemic Involvement. Lung lesions – 95% Thoracic lymph nodes – 50% Skin lesions – 30% 

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SARCOIDOSIS

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  1. SARCOIDOSIS • Idiopathic multisystem disorder • Characterised by non-caseating granulomata • More common in women 20-50 yrs • More common in blacks and Asians • ? Related to mycobacteria

  2. SARCOIDOSISSystemic Involvement • Lung lesions – 95% • Thoracic lymph nodes – 50% • Skin lesions – 30%  • Eyes – 30%

  3. SARCOIDOSISOcular Involvement • Anterior segment lesions (30%) • Conjunctival granuloma • Lacrimal gland involvement/dry eye • Acute or chronic uveitis  • KPs described as ‘mutton fat’ because they are large and greasy

  4. SARCOIDOSISOcular Involvement • Posterior segment lesions (20%) • Patchy venous sheathing • Cellular infiltrate around vessels • Chorioretinal granulonmas • Vasculitis including occlusive causing:- • Neovascularisation • Infiltrate in vitreous (vitritis) including cell clumps (snowballs)

  5. SARCOIDOSISOcular Involvement • Sheathing of the retinal veins • Fluorescein angiography showing leakage and staining at sites of sheathing

  6. SARCOIDOSISGranuloma in Fundus • Retinal and pre-retinal • Choroidal

  7. SARCOIDOSISGranuloma in Fundus • Optic nerve head granuloma • Normal optic nerve head

  8. SARCOIDOSISSystemic Signs Lupus pernio affecting the nose – a chronic progressive cutaneous sarcoid that most commonly affects face and ears

  9. SARCOIDOSISSystemic signs • Facial palsy • Salivary gland enlargement

  10. SARCOIDOSISSystemic signs • Hilar adenopathy on chest x-ray • Lung infiltrate • Erythema nodosum • Arthritis

  11. SARCOIDOSISInvestigations (1) CXR – to detect pulmonary signs • Bilateral hilar lymph-adenopathy • Pulmonary mottling

  12. SARCOIDOSISInvestigations (2) • Serum angiotensin-converting enzyme (ACE) – elevated in active sarcoidosis • Mantoux test – caution in patients who have had BCG vaccination. Test may be negative • Lung function tests

  13. SARCOIDOSISInvestigations (3) Gallium scan showing increased uptake in the lacrimal and parotid glands and pulmonary regions in a patient with active sarcoidosis

  14. SARCOIDOSISTreatment Systemic steroids may be necessary in patients with posterior segment disease where vision is threatened, especially if optic nerve is involved

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