Sarcoidosis

SARCOID = “FLESH FORM”–”RESEMBLING SARCOMA”
SCHAUMANN’S SYNDROME = GENERALIZED SARCOIDOSIS
AN IDIOPATHIC MUSLTISYSTEM CHRONIC GRANULOMATOUS Dz
EPITHELIOID CELLS FUSE TO FORM LANGERHANS GIANT CELLS—FORM THE CLASSIC NON-CASEATING GRANULOMAS
INTRACYTOPLASMIC CONCHOIDAL BODIES, ASTEROID BODIES, AND SCHAUMANN’S BODIES
SARCOID SUB-Q NODULES =”DARRIER ROUSEY” NODULES
3RD – 4TH DECADE, 6-10/100,000
FEMALE>MALE
BLACKS 17:1 WHITES—HOWEVER, HIGH INCIDENCE IN SCANDINAVIA
Sx: LAD, SPLENOMEGALLY, CONSTITUTIONAL Sx (FEVER, WEIGHT LOSS, ARTHRALGIAS), ANERGY, S.Q. NODULES, FATIGUE, MALAISE, SOB, NIGHT SWEATS, HEMOPTYSIS     (SARCOID IS SILENT TO AUSCULTATION)
H&N — RHINORRHEA, UVEITIS, PAROTIDITIS, FACIAL PARALYSIS, SKIN NODULES ”DARRIER ROUSEY” NODULES, SUPRAGLOTTITIS
LUPUS PERNIO= THE CHARACTERISTIC SKIN LESION OF SARCOID AFFECTING THE NOSE, NASAL MUCOSA AND SKIN—LOOKS LIKE RHINOPHYMA
“PUNCHED OUT “ BONEY LESIONS PARTICULARLY OF THE HANDS
CXR—HILAR LAD
MOST CASES RESOLVE WITH IN 2 YEARS
UVEOPAROTID FEVER OF HEERFORDT(-WALDENSTROM):
HEERFORDT’S DISEASE(HEERFORDT-WALDENSTROM SYNDROME)
UVEOPAROTID FEVER
(RESEMBLES SJOGRENS/MIKULICZ SYNDROME)
ANT. UVEITIS
IRIDOCYCLITIS
FACIAL PARALYSIS
MILD FEVER
NON-SUPPURATIVE PAROTIDITIS
FEVER, UVEITIS (IRIDOCYCLITIS), B PAROTITIS, B FACIAL NERVE PARALYSIS (CERVICAL LAD)
LOFGREN’S = FEMALES WITH ASSOC ERYTHEMA NODOSUM
Dx: CXR (90% ABNL), ANERGY PANEL(DEPRESSED T-CELL FUNCTION), PPD 60% NEGATIVE, ACE 83% ELEVATED, CA++, ESR, CBC(LYMPHOCYTOPENIA), SMAC (HIGH LFT’S), SERUN PROTIEN ELECTROPHORESIS(HYPERGLOBULINEMIA(30%)–HIGH IGA &IGG(ALPHA-2 AND BETA-GLOBULIN), HYPOALBUMINEMIA)(REVERSAL OF ALBUMIN/GLOBULIN RATIO), GALLIUM SCAN, ESR, MHATP, UA, FANA/ANA, RF, AUDIO, HIV
KVEIM-SITZBACH TEST (INJECT KVEIM AG=SUSPENSION FROM AFFECTED PTS LN OR SPLEEN, SQ)

TSH, ANTI DNAse, SERUM AMYLASE, SALIVARY AND PANCREATIC ISOENZYMES, CRP

TAIL OF PAROTID BIOPSY
Rx: PREDNISONE 60-80MG QOD FOR 2 MONTHS THEN WEAN TO MAINTENANCE OF 20-60MG
OCCASIONALLY INTRALESIONAL STEROIDS—EPIGLOTTIC LESION (LOOKS LIKE A NON INFLAMMATORY EPIGLOTTITIS)
POSSIBLY MTX
PLAQUENIL(HYDROXYCHLOROQUINE)

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