That Iritating Cough!!
- Male patient mid 30’s previously healthy
- Severe ”fllu” (Swine Flu) followed by
- Persistent dry cough
- Ankle oedema
- Night Sweats
- Decreased effort tolerance
- ECG : Normal
- Urine : analysis Normal
- FBC : Normal
- CRP : Raised (27)
- LFT : Normal
- TFT : Normal
- Cardiac echo : Normal
- Post influenza irritable airways
- Prednisone 20mg dly 2/52
- Zithromax 500mg twice weekly 2/52
- Resolution of dysrhythmia, paedal odema,night sweats, arthralgia and SOB
- Marked improvement in cough
- Hilar adenopathy
- Patchy lung infiltrate
- Right pleural effusion
- CT Chest
- Confirmed hilar lymphadenopathy
- Peribronchial infiltration
- Right sided effusion
- Lung functtons
- Biopsy of mediastinal lymphadenopathy
- Multisystem granulomatous inflammatory disease characterized by non-caseating granulomas
- Theories include infectious, environmental and genetic.
- Granulomatous inflammation characterized primarily by accumulation of monocytes, macrophages and activated Tlymphocytes, with increased production of key inflammatory mediators
- Paradoxic state of simultaneous hyper- and hypo- activity is suggestive of a state of anergy
- Dysregulated calcium metabolism with hypercalcaemia and hypercalciuria
- Incidence: 16-60/100 000
- More common in Northern Europeans and North American Blacks..
- More common in non smokers
- Presentation differs by population
- Blacks – Pulmonary fibrosis
- Japanese – Cardiac (5% mortality)
- Irish/Icelandic – Löfgren’s syndrome
- Chest X-ray changes are diiviided iinto four stages
- Stage 1 bihilar lymphadenopathy
- Stage 2 bihilar lymphadenopathy and reticulonodular infiltrates
- Stage 3 bilateral pulmonary infiltrates
- Stage 4 fibrocystic sarcoidosis typically with upward hilar retraction, cystic & bullous changes
- Acute Sarcoidosis
- Triad of hilar adenopathy, arthralgia and erythema nodosum with or without fever.
- Presentation differs in men and women
- Men: Ankle oedema and arthralgia predominant
- Women: Erythema nodosum predominant
- Imparts better prognosis with >90% of patients in remission at 2 years.
- Immune suppression
- The disease can remit spontaneously or become chronic (>3 year history), with exacerbations and remisions. In some patients, it can progress to pullmonary fibrosis and death.
- Approximately half of the cases resolve or can be cured within 12–36 months and most within 5 years.
- Some cases persist several decades
- Patients with sarcoidosis appear to be at significantly increased risk for cancer, in particular lung cancer, malignant lymphomas, and cancer in other organs known to be affected in sarcoidosis