Links To And Excerpts From The Curbsiders’ #256 Sarcoidosis

In this post I link to and excerpt from The Curbsiders‘ [Link is to the episode list] #256 Sarcoidosis [Link is to the podcast and show notes] FEBRUARY 15, 2021 By DEB GORTH:


Here are excerpts from the show notes:

Sarcoidosis Pearls

  1. The characteristic noncaseating granulomas of sarcoidosis can be thought of as a callus generated by chronic inflammation, more specifically, antigen driven CD4+ T-cell activation and macrophage recruitment (Patterson et al 2017).
  2. Pay close attention when patients complain of  dyspnea, and workup this complaint with sarcoidosis in your differential.
  3. Consider sarcoidosis in patients who have received multiple courses of antibiotics for non-resolving pneumonia or upper-respiratory infection.
  4. About two-thirds of patients who present with bilateral hilar lymphadenopathy will achieve eventual remission, while the remaining third will have chronic disease (Siltzbach et al 1974).
  5. Sarcoidosis is a multisystem systemic disease, requiring a multi-system history and evaluation to avoid missing affected organs.
  6. The central challenge of diagnosing sarcoidosis is ruling out the mimics of this disease: CVID/GLILD, tuberculosis, fungal infection, and lymphoma.
  7. “The diagnosis of sarcoidosis is arbitrarily made when the statistical likelihood of alternative diagnoses becomes too small to warrant further investigation” (Baugham et al 2010).
  8. Both Löfgren’s syndrome and Heerfordt’s syndrome are pathognomonic for sarcoidosis; in these instances a biopsy for diagnosis is not recommended (Crouser et al 2020).
  9. Serum ACE levels have limited diagnostic value for sarcoidosis (Ungprasert et al 2016).
  10. Additional testing to evaluate systemic involvement should include: baseline eye exam, serum creatinine, alkaline phosphatase, serum calcium, 25- and 1,25-OH vitamin D, and an EKG (Crouser et al 2020).
  11. There is little correlation between radiographic findings and patients’ sarcoidosis symptoms or functional capacity (Judson et al 2008 and Karetzky and McDonough 1996).
  12. The cornerstone of therapy for sarcoidosis is glucocorticoids (initial dose prednisone 20-40 mg) (Rahaghi et al 2020).
  13. If a patient isn’t responding to treatment as expected, even after the diagnosis of sarcoid, reconsider your diagnosis and reinvestigate the other sarcoidosis mimickers before considering second line therapies (biologics/immunosuppressive drugs).
  14. Sarcoidosis is a high burden disease; this diagnosis has lots of uncertainty regarding progression, requires the care of multiple different providers, and has debilitating symptoms.
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