- Symbols Glossary
- Symbols and abbreviations
- Part 1 Presentation
- Chapter 1 The peri-arrest patient (incorporating BLS and ALS)
- Chapter 2 Dyspnoea
- Chapter 3 Wheeze and dyspnoea
- Chapter 4 Dyspnoea in specific situations
- Chapter 5 Cough, sputum, and fever
- Chapter 6 Haemoptysis
- Chapter 7 Chest pain
- Chapter 8 Respiratory failure
- Chapter 9 Common chest radiograph presentations
- Part 2 Clinical scenarios
- Chapter 10 Inhalational injury
- Chapter 11 Inhaled foreign bodies
- Chapter 12 Problems related to adverse environments
- Chapter 13 The immunocompromised patient
- Chapter 14 Post lung transplant
- Chapter 15 Superior vena cava obstruction (SVCO)
- Chapter 16 End-stage pulmonary disease
- Chapter 17 Post thoracic surgery
- Part 3 Acute Respiratory Conditions
- Chapter 18 Anaphylaxis
- Chapter 19 Acute respiratory distress syndrome (ARDS)
- Chapter 20 Asthma
- Chapter 21 Chronic obstructive pulmonary disease (COPD)
- Chapter 22 Hyperventilation syndrome
- Chapter 23 Imported infectious respiratory disease
- Chapter 24 Pleural effusion
- Chapter 25 Pleural infection
- Chapter 26 Pneumothorax
- Chapter 27 Pneumonia
- Chapter 28 Pulmonary embolism
- Chapter 29 Pulmonary–renal syndromes
- Chapter 30 Tuberculosis
- Part 4 Chronic respiratory conditions
- Chapter 31 Bronchiectasis
- Chapter 32 Cystic fibrosis
- Chapter 33 HIV and the lung
- Chapter 34 Interstitial lung disease
- Chapter 35 Sarcoidosis
- Chapter 36 Known diagnosis of lung cancer
- Chapter 37 Respiratory problems in neuromuscular disease
- Chapter 38 Pulmonary hypertension
- Chapter 39 Respiratory conditions associated with connective tissue disorders
- Chapter 40 Sickle cell disease
- Chapter 41 Sleep disordered breathing
- Part 5 Practical and management issues
- Chapter 42 Airway management
- Chapter 43 Tracheostomy
- Chapter 44 Oxygen therapy
- Chapter 45 Heliox
- Chapter 46 Nebulizers
- Chapter 47 Non-invasive ventilation
- Chapter 48 Intensive care referral
- Chapter 49 Pre-operative assessment
- Chapter 50 Respiratory physiotherapy
- Chapter 51 Pleural aspiration
- Chapter 52 Chest drain insertion
- Part 6 Investigations
- Chapter 53 Arterial blood gases
- Chapter 54 Pulse oximetry
- Chapter 55 Peak flow
- Chapter 56 Spirometry
- Chapter 57 Bronchoscopy
- Chapter 58 Radiology
(p. 227) Sarcoidosis
- (p. 227) Sarcoidosis
(p. 228) Sarcoidosis
Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It is a relatively rare condition (UK incidence 5–10 in 100 000) and so it is unusual for it to present in the acute medical setting.
Acute sarcoid, previously undiagnosed, may present as Löfgren's syndrome, a combination of erythema nodosum, bilateral hilar lymphadenopathy on the CXR, fever, and arthralgia. This requires no specific treatment (other than simple analgesics or NSAIDs for arthralgia/pain from erythema nodosum) and has an excellent prognosis; the majority will resolve completely within 1–2 years.
In the above situation it is worth checking baseline renal function, calcium, and ACE level (which may be raised in sarcoid, although elevated levels are not diagnostic) and referring for outpatient HRCT/PFT and chest clinic follow up to clarify degree of lymphadenopathy and lack of parenchymal involvement. In this situation biopsy of lymph nodes by mediastinoscopy (to exclude lymphoma/TB) is usually not needed unless there is anything atypical about the situation.
Known diagnosis of sarcoid
Causes of increased shortness of breath, on a background of sarcoid, are most commonly due to the following.
Flare of sarcoid
Comparison of CXR with earlier films is important. Both sarcoid and infection can cause an increase in shadowing on the CXR and discrimination between the two can be difficult, although dense consolidation (especially lobar) is unlikely to be sarcoid. Discuss with chest team about need for starting/increasing existing dose of steroid and arranging appropriate outpatient investigation/review. In treating active disease standard treatment would be prednisolone 40 mg od for 4 weeks before tapering to a maintenance dose, ideally under review of a respiratory physician.
Treat as community-acquired infection. If the patient is on maintenance steroids, consider a transient increase in dose whilst unwell.
(p. 229) Non-respiratory presentation
• Skin: erythema nodosum (symptomatic treatment and NSAIDs), lupus pernio, and cutaneous sarcoid.
• Cardiac sarcoidosis: most commonly presents with conduction defects. Therefore perform ECG on all sarcoid patients.
• Neurosarcoidosis: can present with any neurological symptom. Most common presentation is lower motor neuron facial palsy.
• Ocular sarcoidosis (sight-threatening): usually anterior uveitis. However episcleritis, scleritis, conjunctivitis, glaucoma, and retinal involvement can occur. Require slit-lamp examination. Refer to ophthalmology.
• Renal sarcoidosis: rarely presents with acute renal failure.
Bear in mind that other specialities may well need to be involved in care of patients with extra-pulmonary sarcoidosis. Extra-pulmonary sarcoid is often an indication for high-dose immunosuppressive treatment, particularly the following.
• Cardiac sarcoidosis.
• Lupus pernio.
• Sight-threatening ocular sarcoidosis.
• Hepatic, splenic, or renal sarcoidosis.