the keypoint there
So get away from thinking that
sarcoid only affects the lung
That is only partly true.
You can find these noncaseating
type of granuloma,
What does noncaseating mean?
Meaning that you do not have a
cheeselike appearance within a granuloma
What does a granuloma mean?
Well from immunology, it's a fact that
you have these antigens that are now
encased or imprisoned
within the structure
things that you'll keep in mind
when dealing with your granuloma
is the fact that you
have T-helper1 cells
that are conducting your
and then you have these multinuclear giant
cells which I'll show you pictures of
When you say multisystem, it could be
well maybe these noncaseating granulomas
might be in the liver, could
also be in the intestine,
It doesn't just have
to be in the lung
Skin, joint, heart, nervous
system, liver, sinuses
do not forget that this could be
a multisystem, big time importance.
next, who's your patient?
Most likely a female, african american
or perhaps from Scandinavian countries
So you might be thinking about
Sweden, Norway, Finland and such
We don't really know
what causes it.
But when it does, you'd know that it's the
parenchyma of the lung that's being affected.
What kind of lung
disease is this please?
Obviously we're still
dealing wth restrictive.
We will be dealing with
restrictive for quite some time.
The differentials are quite
large and quite important.
Lung disease, interstitium.
Can you consider all in the diffuse
lung disease differential?
especially Mycobacterium avium
intracellulare type of infection
Next, well are you gonna have
lymphadenopathy with your sarcoidosis?
Absolutely, bilateral hilar
type of lymphadenopathy.
and all that means to you is the fact
that you have more differentials
Need to rule out lymphoma
if it's lymphadenopathy
In other words you're dealing with
an interleukin known as 6 (IL-6)
and Bartonella infection,
and with bartonella of course you're
thinking about cat scratch disease
or with Bartonella in HIV patient,
then you start thinking about
things like bacillary angiomatosis
systemic disease, what it is?
Well depending on the organ system, you
need to consider infiltrated diseases
such as well, say that it's the
heart or the liver, intestine, skin
One of those that will be infected,
well what kind of differentials
might you be thinking?
infiltrative, how about amyloid?
For the neuro, well now you start
thinking about well things like
multiple sclerosis, CNS
do you see as to how sarcoid in which
yes, could be involved with the lung
but is it the lung only that they
have to give you presentation for?
Not at all.
But you do know that if it does
affect the lung at this point,
Restricted lung, take a look
at your differentials here
For all, need biopsy
to confirm sarcoid.
As far as prevention, risk factors -
we call this idiopathic, unknown.
Maybe asymptomatic but
incidental finding, take a look
hilar adenopathy on chest x-ray.
Now you start thinking about
bilateral type of hilar lymphadenopathy
maybe you're thinking also
along the lines of things like Berylliosis
may present with cough and
progressive dyspnea upon exertion,
and young males particularly may
present with acute onset, fever
I'm gonna show you picture
of erythema nodosum
What that is is a patient that
is then going to complain
of pain in the shins of the leg
lymphadenopathy, young males.
Otherwise, you tell me who
your patient most likely is.
But if it's young males particularly
acute onset, fever, erythema nodosum
Often referred to as Lofgren's Syndrome.
Do not get Lofgren's Syndrome confused
with what's known as Loeffler's Syndrome
that we'll take a look at later, okay.
With Loeffler's, there we will be looking
at more or less an issue with eosinophilia
Okay, this is
sarcoid, be careful.
Now with sarcoidosis, if you take a look
at the shin and where it's been shown here
Then you'll find these areas that
are reddened, hence erythema.
Next if it's nodosum, this then
means that you have more or less
your subcutaneous fat that
is going to be affected
Sometimes referred to as being your
panniculitis, now you'd wanna be careful
Find a patient who is complaining of such
pain on the front of the legs, the shin
or maybe there is a description
of erythema nodosum
All it does is just give you
a list of differentials.
If you find your patient to be
positive for erythema nodosum,
and also has hypertension and
also has hypervitaminosis D
and it has a lung involvement,
restrictive lungs disease,
then without a
doubt, it's sarcoid.
But if your patient is maybe
exposed in California,
In California, there might be
earthquakes and such and so therefore
therefore it was then going to release
these endospores into the atmosphere
In which the patient
is now inhaling these,
these are coccidiodes,
these are fungal infection
So what I'm saying is that erythema
nodosum is just a generic differential
that is going to be found in
many, many, many instances
many systemic fungal infection,
Maybe it's going to be Cryptococcus
neoformans in your pigeons
Maybe it's something like your
blastomycosis with the rotten wood,
so on and so forth.
Now with sarcoid, hilar lymphadenopathy,
take a look at the chest X-ray
Now, the medial side of the
lung by the mediastinum,
You find lot of activity in that region
That increased activity that
you find in the middle region medially
then represents the
Remember when you find hilar
think of those conditions that
also affect the lymph nodes
such as lymphoma.
Keep that in mind.