Introduction
Sarcoidosis (from sarc meaning “flesh”, -oid, “like”, and -osis, “diseased or abnormal condition”), also called sarcoid, Besnier–Boeck disease or Besnier–Boeck–Schaumann disease, is a multi organ disease characterized by granulomatous inflammation that commonly affects lungs or lymph nodes,
Etiology: It is because of genetic susceptibility to various environmental agents.
Infective agents: Epstein barr virus, retrovirus, coxasackie, cytomegalo virus, herpes.
Bacterial: Borrelia, chlamydia, mycobacterium TB.
Occupational: Aluminium, Berryllium, Zirconium etc.
| · Common symptoms, which tend to be vague, include fatigue (unrelieved by sleep), lack of energy, weight loss, aches and pains, arthritis, dry eyes, swelling of the knees, blurry vision, shortness of breath, a dry, hacking cough, or skin lesions. · The cutaneous symptoms vary, and range from rashes and noduli (small bumps) to erythema nodosum or lupus pernio. · The combination of erythema nodosum, bilateral hilar lymphadenopathy, and arthralgia is called Löfgren syndrome; it has a relatively good prognosis. · Renal, liver (including portal hypertension), heart or brain involvement may cause further symptoms and altered functioning. |
Signs and symptoms
Lungs
- It is primarily an interstitial lung disease.
- Bilateral hilar lymphadenopathy is characteristic leading later to fibrosis.
- CECT shows ground glass appearance, bronchovascular thickening with lymphadenopathy. On examination wheezing is observed.
- PFT shows restrictive ventilatory defect and reduced DLCO.
Other organs involved are: Skin, heart, nervous system, ocular, hepatic and lymphatic and renal.
Diagnosis
Diagnosis of sarcoidosis is often a matter of exclusion.
- Clinical and radiological findings correlate
- Histological evidence of non- caseasting granuloma
- Exclusion of other diseases with similar histo pathological findings (tuberculin test- negative)
CT scan of the chest showing lymphadenopathy (arrows) in the mediastinum due to sarcoidosis
Chest X-ray changes are divided into 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 and bullous changes
Differential diagnosis:
Metastatic disease, lymphoma, septic emboli, rheumatoid nodules, Wegener’s granulomatosis, varicella infection, and atypical infections, such as Mycobacterium avium complex, cytomegalovirus, and cryptococcus, Mycobacerium
Conventional treatment
- Between 30 and 70% of patients do not require therapy
- Corticosteroids, most commonly prednisolone, have been the standard treatment for many years. In some patients, this treatment can slow or reverse the course of the disease, but other patients do not respond to steroid therapy. The use of corticosteroids in mild disease is controversial because in many cases the disease remits spontaneously. Additionally, corticosteroids have many recognized dose- and duration-related side effects, and their use is generally limited to severe, progressive, or organ-threatening disease. The influence of corticosteroids or other immunosuppressants on the natural history is unclear.
- Severe symptoms are generally treated with steroids, and steroid-sparing agents such as azathioprine and methotrexate are often used. Rarely, cyclophosphamide has also been used. Some early indications of success using immunosuppressants, interleukin-2 inhibitors, or antitumor necrosis factor-alpha treatment (such as infliximab) have been observed.
CASE OF SARCOIDOSIS TREATED BY HOMOEOPATHY
Name- Smt . Shyamdulari Yadav
Age-65 yrs Sex-Female
Occupation-Retired as a house nurse
Marital Status- Married
Address- Near Formica Company, Akurdi, Pune
Diagnosis-? Sarcoidosis
Chief Complaints
- Fever with Generalised weakness since 1 month
- Breathlessness since 4 yrs- Grade 1-Grade 2 since 1 ½ month
ODP: Patient, 65 yr old female, a k/c/o Sarcoidosis, came with complaints of fever with chills, low grade fever, intermittent, assoc with chills, which subsides on medication.
H/O- loss of appetite and weight loss (8-10 kgs)
No H/O cough, cold, vomiting, loose motions.
Associated complaints- Generalised weakness and body ache along with chief complaints
Past History- H/O similar complaints in the past 4 yrs back and she was diagnosed as sarcoidosis 2 yrs back.
H/O TB in 2000- taken AKT for 9 months
Gout since 10-12 yrs. C/O- pain, tingling numbness in hands and legs.
Family History
- Father- apparently well
- Mother- expired due to cardiac illness at the age of 70 yrs
- 2 Brothers- Apparently well
- Husband- Apparently well
Patient as a Person- Lean, Thin, emaciated
Personal History
Appetite- reduced since complaints, does not feel like eating.
Diet- veg
Thirst- increased since complaints, sips of water at short intervals.
Desires- sweets
Aversions- oily, namkeen things and outside food
Habits- tea 4-5 times/day
Bowel- Occ constipated, has to take medicines
Urine- 4-5 times/day. Dark yellow
Perspiration- after heat stage of fever. offensive
Sleep and dreams- sleep disturbed since complaints. 3-4 hrs at night
Dreams – not specific, having varied dreams since admitted in the hospital.
Thermals- Hot Patient
Change of weather- cold, coryza recurrent
Light, Noise-headache
Sun-headache, eyes burn
Open air – prefers
Menstrual history:
Menarchy-12yrs of age
Duration- 3-4/28 days
Quantity- moderate
Colour/stain-blackish, clots+
Before menses- pain in lower abdomen, headache, fever and red eyes
During menses pain is reduced
Menopause-12 yrs back
Obstetric history- G3P3A2L1
G1-female child
G2- MTP
G3-Spontaneous abortion
Mentals
Loquacious female, religious-believes in god, co-operative, communicative, curious wants to know everything about herself, her disease inquisitive.
Anger during her illness especially in fever stage
Love/ attachment- present
Anxiety- about her diseases& future
Fastidious +
Anticipation +
Consolation- better when consoled.
Life history of the patient
A well educated female of 65yrs, belonging to a small place in Bihar, working as a head nurse, midwife in civil hospital for 20-25 yrs. She very well knows about the disease she is suffering from, its causes, symtoms, etc. And feels that it is rare disease, which usually affects only people from the medical field. A very curious and inquisitive type of female.
She is also very ambitious and a career oriented female. She had an MTP done, for the sake of her job. She has only one daughter; she’s married and settled now.
Now left her job has acquired this and is worried about it. Feels when she will get cured of it. Has come all the way from her town place, in order to get cured.
General examination
Temp- 100 F pulse- 100 b/min
BP- 100/70 mm Hg RR- 20 cycles/min
Pallor- present Clubbing- present
Nails- blackish discolouration Tongue- moist
Icterus, oedema, cyanosis, lymphadenopathy- absent
Systemic examination
RS- AEBE
CVS- S1 S2 heard
P/A- soft , non-tender
Locomotor system- Gouty nodules in fingers of hands and legs
Patient is on corticosteroid (Deflacort) treatment since 1 and half month
REPERTORISATION DONE BY RADAR SOFTWARE
Treatment and Investigations done
On 1-1-2013
Treatment given: Lachesis 200 C single dose,SL 4 pills tds for 1 week
Urine R:Albumin-3+, PC- 8-10/hpf, EC- 10-12/hpf
X- ray chest: Diffused parenchyama
C-reactive protein- positive,Blood culture n sensitivity- staph aureus isolated.
RA test- negativeWidal test- negative,
Dengue- negative,HbsAg- negative HIV- negative,
BSL Fasting- 106 mg%,
Follow up on 9.1.2013
No fever, no chills, bodyache reduced, dyspnoea grade II
Pulse-90/min, B.P-110/70mmhg,
pallor present, clubbing present
RS- AE equal on both sides, crepts lower lobes, CVS- S1S2 heard
Urine routine- on 9-1-2013
Albumin- trace,Pus cells2-4/hpf,Epithelial cells-2-4/hpf,
Treatment given: Lachesis 200 C 4pills once a day on alternate days, SL 4 pills BD for 1 month
Follow up on 9.2.2013
G.C fair, No fever, no bodyache, dyspnoea grade I
Pulse-88/min, B.P-118/70mmhg,
pallor present, clubbing present
RS- AE equal on both sides, crepts Rt>LT side , CVS- S1S2 heard
Investigations- on date 9-2-2013
Haemogram- Hb- 8.4gm %,TLC- 17500/cmm,PLt count- 3.6 lacs,ESR- 35 ,LFT’S- Normal
Treatment given: Lachesis 200C 4 pills once a day on alternate days,SL 4 pills BD for 1 month
Follow up on 9.3.2013
G C fair, Dyspnoea grade I, no fever ,
Pulse-86/min, B.P-110/ 80 mmhg,
pallor present, clubbing present
RS- AE equal on both sides, CVS- S1S2 heard
X-ray Chest – Normal
Treatment given: Lachesis 200C 4 pills once a day on alternate days,SL 4 pills BD for 1 month.
Authors:
1) Dr D.B Sharma,M.D(Hom),PGDMLS
2) Dr Vipul Gandhi, M.D(Hom) ,CRCDM
