Dept of Medicine

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Dept of Medicine Pathology CWM Hospital Fiji
School of MedicineWeekly CPC Meeting

• March 13, 2003
• Case of Sarcoidosis

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Patient Details

• 54 Year Fijian Male
• Presented with multiple raised skin lesions
• Bilateral Multiple patchy lung opacities.
• Clinically stable, no lung symptoms.

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Skin lesion Biopsy

• Chronic inflammation in superficial dermis
• Specially around the adnexal structures and blood
  vessels.

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Skin lesion Biopsy

• Granuloma formation
• With giant cell

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Skin lesion Biopsy

• Epidermis
• Chronic inflammation
• Granuloma formation
• Note no caseation necrosis.

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Skin lesion Biopsy

• Epidermis
• Granuloma with giant cell
• Chronic inflammation
• Note no caseation necrosis.

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Skin lesion Biopsy

• Epidermis
• Chronic inflammation
• Note no caseation necrosis.

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Sarcoidosis Discussion

• ? Etiology granulomatous disease.
• Bil. hilar lymphadenopathy/lung 90
• Eye and skin.
• Non caseating granulomas.
• Kveim test positive sarcoid extract
• High ACE in 33-50
• ? Mycobacterial, T cell immune dis?

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Sarcoidosis - Features

• Any or all organ involvement.
• Lungs and LN involved in gt90
• Tight granulomas, giant cells, no caseation,
  hyaline fibrous scar.
• Laminated Ca bodies Schaumann
• Stellate Asteroid bodies in giant cells.

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Sarcoidosis - Features

• Skin - Discrete erythematous nodules or plaques
  with scaling.
• Mucosal involvement, eyes, GIT, RT, Salivary
  glands etc.
• Combined Uveoparoid involvement Mikulicz
  syndrome.

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Clinical Features

• Insidious onset, chronic, remissions.
• Fever Fatigue weight loss, anorexia, night
  sweats.
• Shortness of breath,
• lymphadenopathy, skin lesions.
• 60-70 recover without complication
• 20 permanent lung damage.
• 10 mortality cardiac, CNS, lung fibrosis cor
  pulmonale.
• Prognosis depends on stage.

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Staging prognosis

• I Hilar lymphadenopathy - best
• II - with lung infiltration -
• III - only pulmonary disease - Poor