A 37yo man presents with some raised lesions on the shin. He came with cough and also
complains of arthralgia. Exam: bilateral hilar lymphadenopathy and erythema nodosum is
present. What is the single most likely cause?
a. CD
b. UC
c. Sarcoidosis
d. Streptococcal infection
e. TB
answer: C
Sarcoidosis
Epidemiology
• typically affects young and middle-aged patients
• higher incidence among African Americans and people at northern latitudes e.g. Scandinavia, Canada
Signs and Symptoms
• asymptomatic, cough, dyspnea, fever, arthralgia, malaise, erythema nodosum, chest pain
• chest exam often normal
• common extrapulmonary manifestations
cardiac (arrhythmias, sudden death)
eye involvement (anterior or posterior uveitis)
skin involvement (skin papules, erythema nodosum, lupus pernio)
peripheral lymphadenopathy
arthralgia
hepatomegaly ± splenomegaly
• less common extra-pulmonary manifestations involve bone, CNS, and kidney, cardiac
(arrhythmias, sudden death)
• two acute sarcoid syndromes
Lofgren’s syndrome: fever, erythema nodosum, bilateral hilar lymphadenopathy, arthralgias
Heerfordt-Waldenstrom syndrome: fever, parotid enlargement, anterior uveitis, facial nerve
palsy
Diagnosis: biopsy
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