Sarcoidosis

Sarcoidosis is a rare autoimmune disease where the body's own tissues are attacked leading to small lumps (granulomas). It can affect the lungs, heart, brain, skin and nervous system, eyes and other organs. Sarcoidosis usually affects the lungs or lymph nodes. The skin, liver and eyes are also often affected. Granulomas are small scars on the affected organs. These granulomas are very small and are visible only under a microscope. Tiny granulomas clump together and cause a big scar. Scarring affects the normal functioning of the affected organ. This disease has a tendency to affect more than one organ at a time. In its active phase, sarcoidosis manifests as scar tissues on the affected organs. When sarcoidosis is in a non-active phase, the granulomas do not grow. Sarcoidosis cases are more pronounced among African -Americans. The highest occurrences of Sarcoidosis are noticed among Scandinavians and red-haired Irish women. Sarcoidosis was originally called Hutchinson's disease or Boeck's disease.

Sarcoidosis is treated according to its extent and severity. Symptoms of sarcoidosis include arthritis in the ankles and disturbed heart rhythms. In most cases of mild sarcoidosis, the inflammation is resolved on its own. In severe cases, the damage is permanent. When vital organs are affected by sarcoidosis, it results in death. In many cases, Sarcoidosis does not manifest in any symptoms. A patient suffering from sarcoidosis notices skin and lung problems, weight loss and fatigue. There may be eye problems and arthritis. Patients suffering from this condition may notice shortness of breath and prolonged cough. Skin lesions may appear. Sarcoidosis is noticed during chest x-rays, blood tests and pulmonary function tests. Biopsies of skin lesions or lymph nodes can help in diagnosing sarcoidosis. Oral steroids such as prednisone or prednisolone are used in the treatment of sarcoidosis. Topical creams or ointments are used to treat sarcoidosis of the skin or eyes.

Lung biopsy

Lung biopsy involves removal of small piece of lung tissue to check for any conditions such as sarcoidosis, pulmonary fibrosis and lung cancer. It is essential to keep the physician informed if the patient is pregnant or taking medications such as warfarin or anticoagulants. Do not eat or drink for 8 to 10 hours before the lung biopsy. The secretions in the mouth and airways is dried up with some medications.

Needle lung biopsy is done with a long needle that is inserted through the chest wall. Ultrasound, fluoroscopy or CT scan are used to aid locating the abnormal lung tissue.

Open lung biopsy may need hospitalization for a couple of days. This procedure involves making an incision between the ribs to take a sample of lung tissue. This is preferred when a larger sample is required and is done under anesthesia. An endotracheal tube is passed through the airways to take a sample of lung tissue.

Bronchoscope lung biopsy is done in cases of suspected infection. The bronchoscope is inserted through the nose or mouth into the airways. This type of lung biopsy is used when abnormal tissue is near the breathing tubes.

VATS Video assisted thorascopic surgery involves use of thorasope to remove a sample of lung tissue.

Mediastinoscopy is conducted under general anesthesia. The mediastinoscope is inserted through an incision made between the lungs. Any abnormal tissues or lymph nodes are examined.

Erythema Nodosum

Inflammation of the skin that shows up as painful reddish tender lumps is called Erythema nodosum. This inflammation is usually located in a part of the fatty layer of skin (subcutaneous fat). The size of the lump could vary in size from 1 to 5 cm. The inflammation causes nodular swelling. The inflammation remains for about a week and then becomes flat leaving behind a bruised appearance. They usually show up on the shins (front portion of the legs, just below the knee). Erythema nodosum is a type of panniculitis, i.e. inflammation that can cause nodules below the surface of the skin. The condition is more common among youngsters aged between 12-20 years.

Erythema nodosum settles down on its own after a period of three to six weeks. It may leave behind a temporary bruised appearance or a chronic indentation in the part where the fatty layer has been injured. Though the condition is annoying and painful, the condition does not cause any damage to the internal organs of our body. In adults, the condition is more often seen in women than in men. In kids, it affects boys and girls equally. In a few people the trigger can be identified and in yet a few it cannot be identified. However identifying the trigger becomes very important as it needs to be treated.

Erythema nodosum causes

Erythema nodosum may show up on its own or may occur in association with other conditions. In about 30-50% of cases, the cause is unknown. However the common triggers that may cause Erythema nodosum include:

• Step throat (streptococcal infection) in adults and kids
  
• Fungal diseases
  
• Tuberculosis
  
• Cat scratch disease
  
• Few medications like penicillin, oral contraceptive, Hepatitis B vaccination, etc
  
• Sarcoidosis
  
• Inflammatory bowel diseases
  
• Behcet's disease
  
• Pregnancy
  
• Certain types of cancers like lymphoma, leukemia, etc

Erythema nodosum symptoms

• Painful nodules are commonly seen on the shin and sometimes on the arms, thighs and trunk of the body. The nodule when it first appears is red, hot and firm to touch and becomes flat over a few days. It appears as bruise that is blue in color and later turns yellowish as it fades. A person may develop just a couple of nodules or much more.
  
• Flu-like feeling before the appearance of lumps.
  
• Aching joints and legs before the appearance of lumps. Ankle, knee and wrist joints are the most affected.
  
• Loss of weight.
  
• Symptoms may vary depending on the underlying trigger that caused the condition.

Erythema nodosum diagnosis

• By means of physical examination
  
• Biopsy of the affected area
  
• Blood test to identify the trigger
  
• Chest X-ray in case of TB or sarcoidosis induced condition
  
• Throat swab

Erythema nodosum treatment

• Cortisone injection
  
• Oral cortisone
  
• Anti-inflammatory drugs
  
• Bed rest
  
• Compression bandages
  
• Cool wet compresses