Sarcoidosis in MRCP

SARCOIDOSIS

Sarcoidosis is always a popular question in respiratory section in MRCP. It was first described by a London surgeon-dermatologist, Dr. Jonathan Hutchinson in 1877. The doctor described the findings of a 50 year-old man who had large purple skin plaques on the hands and feet and a 64-year-old woman with large purple patches on her face and arms. You must remember that Sarcoidosis is a multisystem disease with unknown origin, however, in MRCP, two popular systems which are frequently asked are skin and lung.

Clinical Presentations

Usually asymptomatic, however patient may have constitutional symptoms such as fever, malaise and weight loss. Majority of patients have respiratory symptoms such as cough and shortness of breath.
Popular skin condition ( always asked in MRCP) associated with sarcoidosis is Erythema nodusom. Pateints may have arthralgia or bone pain.
Eyes-painful eyes, dry eyes
Other-dry mouth, hepatomegaly

Investigations

They would usually show show you a CXR in MRCP
Remember that 90% of CXRs have bilateral hilar LN enlargement. More advanced case may have diffuse fibrosis!

ESR-raised
Serum Calcium-raised
Serum ACE-raised
Lung function test may show obstructive changes

Diagnosis

Diagnosis can be made by lung biopsy-granuloma! Remember that serum ACE is not specific nor sensitive.

Treatment

The main treatment for sarcoidosis is prednisone. Prednisone is a corticosteroid, or anti-inflammatory drug. Sometimes it is used with other drugs. Sometimes other corticosteroids are used.

Tips for MRCP

1) If you are asked about a patient with painful skin lesions over shin area with dry cough, always think of sarcoidosis.

2) A patient with high calcium level and dry cough , think of sarcoidosis although there is possibility of lung cancer with bone metastasis!