Sarcoidosis is a multisystem granulomatous disease of unknown origin characterized by the formation of non-caseating granulomas. It most commonly affects the lungs and presents as hilar lymphadenopathy and pulmonary infiltration. While the etiology is unknown, infectious agents like mycobacteria have been implicated. Sarcoidosis affects young and middle-aged adults, especially blacks. Specific organ involvement can cause dysfunction. Skin lesions, eye involvement, and lymph node enlargement are common. Histologically, granulomas containing epitheloid cells and multinucleated giant cells are seen without caseation or necrosis. Uveoparotid fever is a rare form involving parotid gland enlargement, u

1. -BY MAHAK
RALLI
(THIRD BDS)

2. SARCOIDOSIS
 Multisystem granulomatous disease of
unknown origin
 It is characterized by formation of
uniform, discrete, compact, non-
caseating epitheloid granulomas.
 Etiology is unknown, but both infective
and non-infective agents have been
implicated.
 Infective etiology is favored with focus
on Mycobacterium and
Propionibacterium.

3. SARCOIDOSIS
 Blacks are more affected than whites.
 Affects young adults and presents with hilar
lymphadenopathy, pulmonary infiltration,
and skin and eye lesion.
 It may involve practically any site, including
lungs, skin, lymph nodes, salivary glands,
spleen and bones and mouth.
 Sarcoidosis is characterized by a
depression of delayed-type hypersensitivity
suggesting impaired cell-mediated
immunity and raised or abnormal serum
immunoglobulins suggesting
lymphoproliferation.

4. CLINICAL FEATURES OF SARCOIDOSIS
 It is an insidious disease. Sypmtoms
are not severe.
 Most commonly seen in young and
middle-aged adults, but it may occur
later in life.
 More common in blacks.
 Mild malaise and cough are chief
features.
 Involvement of a specific organ is
evidenced by dysfunction of that organ.
 Cutaneous lesion may be the only
distinct manifestation in 25-35% cases.

5. Eye lesions in sarcoidosis

6. CLINICAL FEATURES OF SAROIDOSIS
 The cutaneous lesions appear as
multiple, raised red patches that occur in
groups, grow slowly, and do not tend to
ulcerate or crust.
 Erythema nodosum is seen in 15%
cases.
 Involvement of lymph nodes or salivary
glands is manifested only by nodular
enlargement.
 Heaptomegaly and spleenomegaly may
occur owing to presence of disease in
the liver and spleen.

7. Erythema nodosum

8. Lymph node involvement

9. ORAL MANIFESTATION OF SARCOIDOSIS
 There are no cases of sarcoidosis of the
oral cavity and jaws reported in literature. It
is hence difficult to describe typical lesions.
 Lesions on the lips that have been reported
were manifested clinically as small, pauplar
nodules or plaques, or resembled herpetic
lesions or ‘fever blisters’.
 On palate and buccal mucosa, lesions are
bleb-like containing a clear yellowish fluid,
or as solid nodules.
 It also appears that sarcoid may produce
diffuse destruction of bone.

11. HISTOLOGIC FEATURES OF SARCOIDOSIS
 Sarcoid lesions closely resemble proliferative
nodules of tuberculosis and differential
diagnosis is difficult to establish.
 No acid-fast organisms can be demonstrated
in tissue section of sarcoidosis.
 Nests of epitheloid cells, with multinucleated
giant cells are one of the chief microscopic
features.
 T and B cells along with various
immunoglobulins can be demonstrated b
appropriate immunofluorescence.

12. HISTOLOGIC FEATURES OF SARCOIDOSIS
 Caseation and necrosis do not
occur, although the granuloma
ultimately transforms into a solid
amorphous, eosinophilic and
hyaline mass as it ages.

13. DIFFERENCE WITH TUBERCULOSIS
 Tuberculin reaction is as positive in
sarcoid patients as it is in the general
population.
 Low incidence of complement-fixing
antibodies against tuberculosis is seen.
If present, antibody titre is very low.

14. DIAGNOSIS OF SARCOIDOSIS
 An intracutaneous test, the Kvim-
Siltzbach test which utilizes a
suspension of human known sarcoidal
tissue as a test agent.
 The test has indicated a high degree of
specificity with a few false positive
reactions.

15. UVEOPAROTID FEVER
 It is a form of sarcoidosis in which
enlargement of the parotid glands,
accompanied by inflammation of the
uveal tracts of the eye and cranial nerve
involvement, and even the lacrimal
glands may be swollen, all features
suggestive of Mikulicz’s disease or
Sjogren’s syndrome.

16. Clinical features
 A chronic, low grade fever is often
present
 Complains of lassitude, malaise and
vague gastrointestinal disturbances or
even nausea, and vomiting.
 Xerostomia.
 A patchy erythema of skin in early
stages of the disease.
 Enlargement of cervical lymph nodes

17. CLINICAL FEATURES
 Most common eye lesion in uveoparotitis,
and often the earliest symptom is uveitis,
but conjuctivitis, keratitis and corneal
herpes among others have also been
reported.
 Uveitis may begin unilaterally, but becomes
bilateral in most cases and results in
permanent visual impairment.
 Unilateral or bilateral seventh nerve
paralysis occurs in one-third to one-half of
all cases.

18. Midline lethal granuloma
 It is the most unusual condition,
resembling a serious infection, which
has been described as an idiopathic
progressive destruction of nose,
paransal sinuses, palate, face and
pharynx.
 Many different specific diseases may
have the same clinical manifestation as
originally described for midline lethal
granuloma.