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From the American College of Rheumatology

Rheumatology for Primary Care
  • Symptoms
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  • Case Studies
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Sarcoidosis Case Studies

Home ยป Sarcoidosis Case Studies
Sarcoidosis Case Studies
  • Case 1

  • Case 2

  • Case 1

A 33 yo F with no other past medical history other than bilateral Bell’s palsy that resolved years ago presented to the ED, as she was found down, unconscious near a café.

She was successfully resuscitated after requiring emergency treatment for sudden cardiac arrest.

Echocardiogram revealed severe biventricular failure with inferior posterior septal wall motion abnormality. A heart catherization was performed, which showed mild non-obstructive coronary artery disease.

What is the next best step?

  1. Monitor on telemetry
  2. Start aspirin
  3. Obtain cardiac MRI
  4. Call cardiac electrophysiology consult
Show Next Step
  • Case 2

A 37 yo F with hx of well-controlled asthma on albuterol prn presented to the ER with an erythematous, nonpruritic, painful, nodular rash of 1 week’s duration on her legs and new onset of joint pain. Two days prior to her ER visit, she noted bilateral, left greater than right, ankle pain, redness, and swelling. She was afebrile with normal heart rate, blood pressure, and oxygen saturation on room air.

Physical exam was notable for erythematous painful nodules scattered on her lower legs. Ankles had full range of motion with erythema and diffuse soft tissue swelling. No effusion was palpated in the ankle joints. Laboratory data revealed elevated inflammatory markers but normal calcium, creatinine, and LFTs. Telemonitor did not show any arrhythmias.

What is the next best step?

  1. Start corticosteroids
  2. Discharge patient with dermatology and rheumatology follow-up
  3. Obtain baseline chest x-ray
  4. Obtain baseline EKG
  5. Obtain 1,25 OH vit D levels
  6. Obtain ankle x-rays
  7. If arthritis and/or skin lesions (that seem characteristically erythema nodosum) do not resolve with course of steroids, consider options for second-line therapies
Show Next Step

Answer: Obtain cardiac MRI

Patients with sarcoidosis commonly have asymptomatic heart involvement, but sarcoid can affect any part of the heart, most commonly presenting with conduction abnormalities. Sudden death caused by heart block or ventricular arrhythmias is the most feared complication. Cardiac MRI and cardiac FDG-PET scans are highly sensitive and specific in the assessment of patients with cardiac sarcoidosis suspected by clinical symptoms or screening tests.

Answer: Obtain chest x-ray

Patient is presenting with erythema nodosum and has periarthritis of her ankles. High suspicion for Lofgren’s syndrome, and a chest x-ray would be the next best step to evaluate for any hilar lymphadenopathy.

Related Links

Sarcoidosis Overview

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ACR2024-05-21T13:53:48+00:00

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This product was funded by a medical grant from Pfizer. The content was written by a physician work group. See Authors

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