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In this video, we're going to see about sarcoidosis
Let's begin!
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So sarcoidosis it's a disease of unknown etiology
which means the cause of the disease is not exactly known.
And there is multi organ involvement in sarcoidosis.
which means various organs are involved in the patients of sarcoidosis.
So this picture is taken from Wikimedia.
This shows the common involvements in sarcoidosis
the patient can have organ involvement starting from head to toe anywhere and everywhere
for example here you can see in this patient there are brain complications
which is marked in the top
and there are few skin lesions which are marked in the legs
such as a erythema nodosum so there can be symptoms and signs anywhere in the body
the most commonly involved organ in sarcoidosis is lungs
which will lead to development of granulomas
and finally development of nodules so
let's see about individual things one by one and we'll get a clearer area of sarcoidosis.
So sarcoidosis is a systemic granulomatous disease which means
there will be formation of granulomas in
multiple organs in the body. Now what is granuloma? Granuloma is one of a
manifestation of chronic inflammation
This type of granuloma is non-caseating
so there are many diseases in which the formation of granulomas along with caseous necrosis
But in this condition in sarcoidosis the granulomas are non-caseating
which means there'll be granulomas but there won't be caseous necrosis
now this is a microscopic picture of granuloma
as you can see here there are multiple cells over here which looks like epithelium dispersed throughout the slide
they're actually activated macrophages which are known as epithelioid cells
and you can see a big cell with multiple nucleus at about 10 o clock position
that is a multinucleated giant cell
so these are the main features of granulomas
so how do the patients present in case of sarcoidosis
most commonly the patients are asymptomatic
they come to be diagnosed with sarcoidosis mostly by a chest x-ray
which has been done for some other cause
and on chest x-ray we can find nodular...
presence of nodules on the lungs or we
can see hilar lymphadenopathy so they
can also present with respiratory symptoms because of lung involvement
and erythema nodosum and arthralgia which are skin and joint involvements
are common in many patients
ocular symptoms such as uveitis which
can lead to pain, blurring of vision and
all that can occur in these patients
skin involvement is also common.
Superficial lymphadenopathy which means enlargement of the lymph nodes around the neck is also common
and there can also be other some other symptoms or other signs
such as elevated calcium levels in the blood which is called as hypercalcemia
and there can be hepatomegaly which is enlargement of the liver
and splenomegaly which is enlargement of the spleen
So now let us see the pathogenesis of sarcoidosis
Pathogenesis of sarcoidosis is not clearly known as I told you earlier
it is a disease of unknown etiology but it has been thought that there is the cause of sarcoidosis
is due to immune dysregulation in few genetically predisposed individuals
so in few people who are genetically predisposed
there is some sort of immune dysregulation
which will lead to increased CD4 positive T helper cell activity
okay so this activity of the CD4 positive T helper cells increases and they start to produce
lot of cytokines such as IL-2, interferon gamma, interleukin 8, tumor necrosis factor etc.,
all these are pro-inflammatory
and they increase the inflammation leading to the development of granulomas
so what happens is there will be multiple granulomas formation over
organs such as lungs liver spleen etc
and all these granules coalesce together to form consolidation and the consolidation
enlarges to form nodules which are about one to two centimeter in size  and they are palpable
so the nodules are most commonly seen in lungs liver and spleen of patients of sarcoidosis
The most common finding in about 90% of the cases of sarcoidosis is bilateral hilar lymphadenopathy
which means lymphadenopathy or disease or enlargement of the lymph nodes which
are present around the lungs so this is the most common finding in about 90% of the patients of sarcoidosis
so this is the gross appearance or gross picture of bilateral hilar lymphadenopathy
As you can see here the hilar lymph nodes are so much enlarged in this picture
This is one of the most common finding in sarcoidosis.
So the nodules as I told you earlier is
formed by consolidation of various granulomas
The granulomas which are present at nearby sites join together or coalesce together to form
a consolidation and that will join together to form nodules
The nodules are most commonly seen in lungs, spleen and liver.
As a result of that slowly the liver begins to enlarge in size leading to development of hepatomegaly
the spleen also enlarge in size which is also known as splenomegaly
Skin lesions are very common, say, very very common in the patients of sarcoidosis
Various types of lesions can occur in the skin of these patients
they can be erythematous plaques which are red lesions present on the skin or they can
be various other types of skin lesions in these patients
which can be one of the factor which brings the patient to the doctor
the most common skin lesion which is found as a patients of sarcoidosis is erythema nodosum
Erythema nodosum is actually not a disease of
skin per se, not the upper layers of the skin
It is the inflammation of the subcutaneous tissue which is present under the skin
which should lead to a presentation of somewhat like this
you can see red lesions on the skin
if you palpate them, you can actually feel the raised surface around normal skin surface
This is the common presentation of sarcoidosis
Eye involvement is also very common in these patients
The most common association of sarcoidosis in relation to eye is
something known as uveitis which is
inflammation of the uvea which is the vascular coat present inside the eye
The uvea includes three divisions such as
Iris, ciliary body and choroid. All this
individually or together can be inflamed
leading to conditions such as iritis, iridocyclitis, etc.,
On long-standing cases there can be corneal opacity
glaucoma and all these worsens to develop total vision loss
Vision of the patient can be affected so severely
Lacrimation is also suppressed in these patients because
we all know that lacrimation is production of tears from the lacrimal gland
so what can happen is sarcoidosis can affect lacrimal glands also
there can be granuloma formation in sarcoidosis
which can affect its function so tears production can be affected
This can lead to decreased lacrimation in these patients
Musculoskeletal system is also involved in few patients.
There can be muscle weakness, tenderness and fatigue of the muscles.
This can be brought out in patients.. in few patients of sarcoidosis
In most of the cases, this is not the presenting complaint in most of the patients
if you're gonna see they're gonna present with respiratory symptoms, skin lesions or eye problems
but this is not one of the major complaint. You need to ask history regarding this to bring this out to light
Okay? So this is accompanied by arthralgia which is pain of the joints
It can involve bones also.
Most commonly involved bones are the bones which are present in the phalanges
the phalanges of hands and the phalanges of feet
Now let's see about the treatment of sarcoidosis.
In mild cases if there is acute attack of say erythema nodosum or some other complications
we can treat that with NSAID's and low dose corticosteroids
okay.. So, if there are increased respiratory symptoms such as
which can be due to increased involvement of the lung. We can increase the dose of corticosteroids
Increasing the dose of corticosteroids can help in those cases
but in severe cases you need to treat the patients severely with
drugs such as methotrexate, azathioprine which are immunosuppressants actually
they are anti-cancer drugs okay so these
drugs are associated with increased side effects or let's say adverse drug reactions
such as alopecia which is hair loss and so the treatment of
severe cases can itself lead to various other complications
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