Sarcoidosis (Löfgren's)



Background

Lofgren's syndrome

Triad of

  • Bilateral Hilar Lymphadenopathy (BHL)
  • Acute polyarthritis
  • Erythema nodosum

Clinical

Symptoms

  • Respiratory (cough, SOB, wheeze, chest pain)
  • Low energy, Joint pains

Examination

  • Respiratory exam. (plus arthritis, low grade pyrexia)

Investigations

  • Regular PFTs
    • (initial ↓ CO diffusion capacity
    • (later restrictive pattern)
  • CXR
  • Lymphopenia, ↑Ca++, ↑ACE levels
Sarcoidosis 01

Scadding classif. Pulmonary Involvement

Stage 0: Normal CXR

Stage 1: BHL

Stage 2: BHL & parenchymal changes

Stage 3: Parenchymal infiltration (no BHL)

Stage 4: Lung fibrosis


Management

Therapy (immunosuppression, Steroids, MTX, Azothioprine) indications

  • Hypercalcaemia
  • Cardiac involvement
  • Neurological
  • Eye involvement (Ant. & Post. uveitis, optic neuritis retinal vasculitis, conjunctivitis)
    • Eye involvement in 20% of all cases. Late complications incl. cataract, glaucoma
    • Heerfordt's synd. = ant. uveitis, parotitis, facial palsy, fever
  • Progressive pulmonary disease

Content by Dr. Íomhar O' Sullivan 20/06/2011. Last review Dr. ÍOS 9/09/14.