2.13 Sarcoidosis

Pulmonary system review for the USMLE Step 1 Exam

• Sarcoidosis is a multisystem inflammatory disorder with non-caseating granulomas in various organs
• Most commonly affects the lungs and causes restrictive lung disease
• Classic patient is a young black female in her 20-30s, but can affect any gender or race
• Symptoms vary depending on which organs are affected, and can include uveitis, skin lesions, joint pain, and swollen lymph nodes
• Bilateral hilar lymphadenopathy is a classic chest X-ray finding
• Restrictive lung pattern on spirometry with normal FEV1/FEV ratio and decreased total lung capacity
• Bells palsy can be a rare symptom caused by inflammation of the facial nerve (CN VII) and external compression by granulomatous mass
• Non-progressive sarcoidosis doesn't need treatment, but patients with respiratory symptoms or bells palsy can be given immunosuppressants like corticosteroids or methotrexate.