Thursday, April 20, 2006

Sarcoid: treat now or diagnose first?

Dr Curry would like to know:
In a 42 year old African-American woman with symmetric bilateral hilar adenopathy symptomatic (dyspnea on exertion), and an eye exam "consistent with sarcoid", would you treat (steroids) based on this or would you first proceed to TBBx for confirmation of the diagnosis? Of note, her spiro is normal.

3 comments - CLICK HERE to read & add your own!:

Baleeiro said...

I think the presentation is very consistent with sarcoid. A CxR consisten with stage I sarcoid with a fitting clinical picture has a very good diagnostic accuracy.
However, with regards to treatment, first I would like some more info such as PFTs, TOB Hx and maybe a High-res. The question is whether the sarcoid is causing the dyspnea or not. If she had fairly normal PFT's with stage I sarcoid I might be inclined to look at other reasons for the dyspnea (i.e. heart, RADS, etc.)

Jeff H said...

I would need more information regarding the eye exam consistent with sarcoidosis. Does this mean there is an anterior uveitis? If so, I would treat with a topical steroid while further evaluating the dyspnea as suggested by Baleeiro.

If there is a posterior uveitis, I would more aggressively persue a definitive diagnosis, as that alone may be an indication for systemic corticosteroids.

Grant Corriveau said...

As a sarc patient, I'm curious. Are any of you aware that sarc has been determined to be caused by CWD bacterial infection causing uncontrolled TH1 inflammation? And that tremendous success is being seen with longterm lowdose ABX cocktail?

Specifically called the Marshall Protocol:

Ask me how I know :-)