SlideShare a Scribd company logo
1 of 8
COMPLEX PRESENTATION OF SARCOIDOSIS IN A DEAF
ADOLESCENT: A CASE STUDY
House M.D s05e21- Saviors
CASE SUMMARY
 Seth, a deaf adolescent with a history of wrestling-related weight cutting and
previous tobacco use, presented with a complex array of symptoms including
seizures, blindness, post-operative fever, and respiratory distress. Given his
inability to communicate verbally, diagnostic evaluation was challenging. Initial
differential diagnoses included thrombocythemia, pulmonary embolism, and
multiple sclerosis (MS). However, further investigation revealed tobacco stains
on Seth's teeth, suggesting a potential link between his past tobacco use and his
current condition. Examination of enlarged lymph nodes and clinical
observations supported the diagnosis of sarcoidosis, a systemic inflammatory
disease characterized by granulomatous inflammation. Treatment with
corticosteroids and methotrexate was initiated, leading to symptom
improvement and stabilization of Seth's condition. Seth's mother played a crucial
role in advocating for his care and facilitating communication with the medical
team. Long-term management and monitoring are essential to assess treatment
response and disease progression in Seth's case. This case highlights the
importance of thorough diagnostic evaluation, effective communication
strategies for patients with special needs, and individualized treatment planning
in optimizing patient outcomes
DIAGNOSIS
1. Medical History and Physical Examination: The healthcare provider will begin by
obtaining a detailed medical history, including symptoms, risk factors, and past
medical conditions. They will then perform a thorough physical examination to
assess for signs of sarcoidosis, such as enlarged lymph nodes, skin lesions, or
respiratory symptoms.
2. Laboratory Tests: Blood tests may be ordered to assess for markers of
inflammation and organ dysfunction. Common laboratory tests include:
 Complete blood count (CBC)
 Comprehensive metabolic panel (CMP)
 Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
 Serum calcium levels
 Liver function tests
DIAGNOSIS
3. Imaging Studies: Imaging tests are crucial for evaluating the extent and severity of sarcoidosis
involvement in various organs. Common imaging studies include:
 Chest X-ray: This may reveal characteristic findings such as bilateral hilar lymphadenopathy and
pulmonary infiltrates.
 High-resolution computed tomography (HRCT) scan: HRCT provides detailed images of the lungs
and is more sensitive than chest X-ray for detecting lung abnormalities.
 Magnetic resonance imaging (MRI) or computed tomography (CT) scan: These imaging modalities
may be used to assess involvement of other organs such as the heart, liver, spleen, or central
nervous system.
4. Pulmonary Function Tests (PFTs): PFTs help assess lung function and detect respiratory
impairment, which is common in sarcoidosis. Spirometry, lung volume measurements, and
diffusion capacity tests may be performed.
DIAGNOSIS
5.Tissue Biopsy: When indicated, a tissue biopsy is often necessary to confirm the diagnosis of sarcoidosis
and rule out other conditions with similar presentations. Biopsy samples can be obtained from affected
organs, such as the lungs, skin, lymph nodes, or other involved tissues. Histopathological examination of
biopsy specimens typically reveals non-caseating granulomas, a hallmark of sarcoidosis.
6.Specialized Tests: In some cases, specialized tests may be performed to assess specific organ
involvement or complications of sarcoidosis. These tests may include:
 Electrocardiogram (ECG) or echocardiogram: To evaluate cardiac function and detect cardiac manifestations.
 Ophthalmic examination: To assess for ocular involvement, such as uveitis or granulomatous inflammation of
the eyes.
 Neurological tests: To evaluate for central nervous system involvement, which may include imaging studies,
lumbar puncture, or nerve conduction studies.
7. Exclusion of Other Conditions: Sarcoidosis is a diagnosis of exclusion, meaning other conditions with
similar clinical features must be ruled out. Differential diagnoses may include infections, autoimmune
diseases, malignancies, and other granulomatous disorders.
TREATMENT
 Corticosteroids:
 Mechanism of Action: Corticosteroids exert anti-inflammatory and immunosuppressive effects
by inhibiting pro-inflammatory cytokines and immune cell activity.
 Regular Dosage: Initial dosage typically ranges from 20 to 40 mg/day orally, tapered gradually to
the lowest effective maintenance dose.
 Potential Adverse Effects: Include adrenal suppression, immunosuppression, metabolic effects
(e.g., hyperglycemia), osteoporosis, and gastrointestinal effects.
 Methotrexate:
 Mechanism of Action: Inhibits dihydrofolate reductase, leading to inhibition of DNA synthesis
and cell proliferation.
 Regular Dosage: Administered orally or intramuscularly once weekly, with initial dosage of 7.5 to
15 mg/m2.
 Potential Adverse Effects: Include hematologic toxicity, hepatotoxicity, gastrointestinal effects,
pulmonary toxicity, and renal toxicity.
 Other Immunosuppressants:
 Azathioprine: Suppresses T-cell and B-cell function, typically administered orally at a starting
dosage of 1 to 2 mg/kg/day.
 Mycophenolate Mofetil: Inhibits T-cell and B-cell proliferation, administered orally at a dosage
of 1 to 1.5 g twice daily.
TREATMENT
 Biologic Agents:
 TNF Inhibitors: Target TNF-alpha, administered via subcutaneous or intravenous routes
for severe, refractory sarcoidosis.
 Monoclonal Antibodies: Target IL-12 and IL-23, administered via subcutaneous injection
for modulating T-cell-mediated immune responses.
 Interactions and Precautions:
 Drug Interactions: Pharmacists should monitor for interactions with other
medications, particularly NSAIDs, anticoagulants, and vaccines.
 Contraindications: Active infections, pregnancy, breastfeeding, severe hepatic or
renal impairment, and hypersensitivity to medications.
 Monitoring: Regular monitoring of complete blood count, liver function tests, renal
function tests, and inflammatory markers is essential to assess treatment response
and detect adverse effects.
CONCLUSION
 Regular monitoring of treatment response and adverse effects allows
for timely adjustments to therapy and optimization of therapeutic
outcomes. Ultimately, a multidisciplinary approach that encompasses
the expertise of healthcare professionals, including physicians, nurses,
pharmacists, and other allied health professionals, is essential for
delivering comprehensive and patient-centered care to individuals with
sarcoidosis.

More Related Content

Similar to Complex Presentation of Sarcoidosis in a Deaf Adolescent.pptx

Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE)Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE)Arwa H. Al-Onayzan
 
Cardiopulmonary Conditions Instructions(Must be included in pape.docx
Cardiopulmonary Conditions Instructions(Must be included in pape.docxCardiopulmonary Conditions Instructions(Must be included in pape.docx
Cardiopulmonary Conditions Instructions(Must be included in pape.docxannandleola
 
Pancreatitis Lab Report
Pancreatitis Lab ReportPancreatitis Lab Report
Pancreatitis Lab ReportHolly Vega
 
Rheumatology MCQs Practice questions with explanation
Rheumatology MCQs Practice questions with explanationRheumatology MCQs Practice questions with explanation
Rheumatology MCQs Practice questions with explanationDr. Almas A
 
A Detailed study on Lupus Nephritis
A Detailed study on Lupus NephritisA Detailed study on Lupus Nephritis
A Detailed study on Lupus NephritisShaswat Nayak
 
Diagnosis of poisoning in children
Diagnosis of poisoning  in childrenDiagnosis of poisoning  in children
Diagnosis of poisoning in childrenدعاء محمد
 
Sarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Sarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNSarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Sarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNiteshYadav723617
 
Clinically Isolated syndrome.pptx
Clinically Isolated syndrome.pptxClinically Isolated syndrome.pptx
Clinically Isolated syndrome.pptxMohamed AbdElhady
 
Mustard gas poisoning .By- Dr mohammadullah totakhil
Mustard gas poisoning .By- Dr mohammadullah totakhilMustard gas poisoning .By- Dr mohammadullah totakhil
Mustard gas poisoning .By- Dr mohammadullah totakhilMohammadullah Totakhel
 
Scleritis & episcleritis
Scleritis & episcleritisScleritis & episcleritis
Scleritis & episcleritisPramod Sharma
 
L 1. introduction to medicine
L 1. introduction to medicineL 1. introduction to medicine
L 1. introduction to medicineDr Bilal Natiq
 
L 1.introduction to medicine
L 1.introduction to medicineL 1.introduction to medicine
L 1.introduction to medicineDr Bilal Natiq
 

Similar to Complex Presentation of Sarcoidosis in a Deaf Adolescent.pptx (20)

Treatment of diffuse systemic sclerosis with AIMSPRO
Treatment of diffuse systemic sclerosis with AIMSPROTreatment of diffuse systemic sclerosis with AIMSPRO
Treatment of diffuse systemic sclerosis with AIMSPRO
 
Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE)Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE)
 
Cardiopulmonary Conditions Instructions(Must be included in pape.docx
Cardiopulmonary Conditions Instructions(Must be included in pape.docxCardiopulmonary Conditions Instructions(Must be included in pape.docx
Cardiopulmonary Conditions Instructions(Must be included in pape.docx
 
Pancreatitis Lab Report
Pancreatitis Lab ReportPancreatitis Lab Report
Pancreatitis Lab Report
 
Rheumatology MCQs Practice questions with explanation
Rheumatology MCQs Practice questions with explanationRheumatology MCQs Practice questions with explanation
Rheumatology MCQs Practice questions with explanation
 
SLE.ppt.pptx
SLE.ppt.pptxSLE.ppt.pptx
SLE.ppt.pptx
 
A Detailed study on Lupus Nephritis
A Detailed study on Lupus NephritisA Detailed study on Lupus Nephritis
A Detailed study on Lupus Nephritis
 
A Descriptive Study of Differentially Placed Hydatid cysts
A Descriptive Study of Differentially Placed Hydatid cysts A Descriptive Study of Differentially Placed Hydatid cysts
A Descriptive Study of Differentially Placed Hydatid cysts
 
Diagnosis of poisoning in children
Diagnosis of poisoning  in childrenDiagnosis of poisoning  in children
Diagnosis of poisoning in children
 
Mixed connective tissue disorder
Mixed connective tissue disorderMixed connective tissue disorder
Mixed connective tissue disorder
 
DrRobertFoxUtahSSF
DrRobertFoxUtahSSFDrRobertFoxUtahSSF
DrRobertFoxUtahSSF
 
Sarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Sarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNSarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Sarcoidosis....pptxNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
 
Clinically Isolated syndrome.pptx
Clinically Isolated syndrome.pptxClinically Isolated syndrome.pptx
Clinically Isolated syndrome.pptx
 
Mustard gas poisoning .By- Dr mohammadullah totakhil
Mustard gas poisoning .By- Dr mohammadullah totakhilMustard gas poisoning .By- Dr mohammadullah totakhil
Mustard gas poisoning .By- Dr mohammadullah totakhil
 
Scleritis & episcleritis
Scleritis & episcleritisScleritis & episcleritis
Scleritis & episcleritis
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
SLE
SLESLE
SLE
 
L 1. introduction to medicine
L 1. introduction to medicineL 1. introduction to medicine
L 1. introduction to medicine
 
CCR3.pdf
CCR3.pdfCCR3.pdf
CCR3.pdf
 
L 1.introduction to medicine
L 1.introduction to medicineL 1.introduction to medicine
L 1.introduction to medicine
 

Recently uploaded

CNN-based plastic waste detection system
CNN-based plastic waste detection systemCNN-based plastic waste detection system
CNN-based plastic waste detection systemBOHRInternationalJou1
 
CT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic traumaCT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic traumassuser144901
 
Anuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatmentAnuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatmentabdeli bhadarva
 
Impact of cancers therapies on the loss in cardiac function, myocardial fffic...
Impact of cancers therapies on the loss in cardiac function, myocardial fffic...Impact of cancers therapies on the loss in cardiac function, myocardial fffic...
Impact of cancers therapies on the loss in cardiac function, myocardial fffic...Catherine Liao
 
Introducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European UnionIntroducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European UnionGolden Helix
 
NCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDF
NCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDFNCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDF
NCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDFShahid Hussain
 
BMK Glycidic Acid (sodium salt) CAS 5449-12-7 Pharmaceutical intermediates
BMK Glycidic Acid (sodium salt)  CAS 5449-12-7 Pharmaceutical intermediatesBMK Glycidic Acid (sodium salt)  CAS 5449-12-7 Pharmaceutical intermediates
BMK Glycidic Acid (sodium salt) CAS 5449-12-7 Pharmaceutical intermediatesdorademei
 
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartCardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartMedicoseAcademics
 
Compare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from homeCompare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from homeCatherine Liao
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxDr. Rabia Inam Gandapore
 
Creating Accessible Public Health Communications
Creating Accessible Public Health CommunicationsCreating Accessible Public Health Communications
Creating Accessible Public Health Communicationskatiequigley33
 
Cas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best suppler
Cas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best supplerCas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best suppler
Cas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best supplerSherrylee83
 
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale nowSherrylee83
 
linearity concept of significance, standard deviation, chi square test, stude...
linearity concept of significance, standard deviation, chi square test, stude...linearity concept of significance, standard deviation, chi square test, stude...
linearity concept of significance, standard deviation, chi square test, stude...KavyasriPuttamreddy
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxdrtabassum4
 
End Feel -joint end feel - Normal and Abnormal end feel
End Feel -joint end feel - Normal and Abnormal end feelEnd Feel -joint end feel - Normal and Abnormal end feel
End Feel -joint end feel - Normal and Abnormal end feeldranji1
 
MRI Artifacts and Their Remedies/Corrections.pptx
MRI Artifacts and Their Remedies/Corrections.pptxMRI Artifacts and Their Remedies/Corrections.pptx
MRI Artifacts and Their Remedies/Corrections.pptxDr. Dheeraj Kumar
 
Circulation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationCirculation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationMedicoseAcademics
 
CURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptx
CURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptxCURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptx
CURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptxDr KHALID B.M
 
Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Anjali Parmar
 

Recently uploaded (20)

CNN-based plastic waste detection system
CNN-based plastic waste detection systemCNN-based plastic waste detection system
CNN-based plastic waste detection system
 
CT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic traumaCT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic trauma
 
Anuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatmentAnuman- An inference for helpful in diagnosis and treatment
Anuman- An inference for helpful in diagnosis and treatment
 
Impact of cancers therapies on the loss in cardiac function, myocardial fffic...
Impact of cancers therapies on the loss in cardiac function, myocardial fffic...Impact of cancers therapies on the loss in cardiac function, myocardial fffic...
Impact of cancers therapies on the loss in cardiac function, myocardial fffic...
 
Introducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European UnionIntroducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European Union
 
NCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDF
NCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDFNCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDF
NCLEX RN REVIEW EXAM CONTENT BLUE BOOK PDF
 
BMK Glycidic Acid (sodium salt) CAS 5449-12-7 Pharmaceutical intermediates
BMK Glycidic Acid (sodium salt)  CAS 5449-12-7 Pharmaceutical intermediatesBMK Glycidic Acid (sodium salt)  CAS 5449-12-7 Pharmaceutical intermediates
BMK Glycidic Acid (sodium salt) CAS 5449-12-7 Pharmaceutical intermediates
 
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartCardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
 
Compare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from homeCompare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from home
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
 
Creating Accessible Public Health Communications
Creating Accessible Public Health CommunicationsCreating Accessible Public Health Communications
Creating Accessible Public Health Communications
 
Cas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best suppler
Cas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best supplerCas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best suppler
Cas 28578-16-7 PMK ethyl glycidate ( new PMK powder) best suppler
 
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
 
linearity concept of significance, standard deviation, chi square test, stude...
linearity concept of significance, standard deviation, chi square test, stude...linearity concept of significance, standard deviation, chi square test, stude...
linearity concept of significance, standard deviation, chi square test, stude...
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
 
End Feel -joint end feel - Normal and Abnormal end feel
End Feel -joint end feel - Normal and Abnormal end feelEnd Feel -joint end feel - Normal and Abnormal end feel
End Feel -joint end feel - Normal and Abnormal end feel
 
MRI Artifacts and Their Remedies/Corrections.pptx
MRI Artifacts and Their Remedies/Corrections.pptxMRI Artifacts and Their Remedies/Corrections.pptx
MRI Artifacts and Their Remedies/Corrections.pptx
 
Circulation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationCirculation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulation
 
CURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptx
CURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptxCURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptx
CURRENT HEALTH PROBLEMS AND ITS SOLUTION BY AYURVEDA.pptx
 
Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.
 

Complex Presentation of Sarcoidosis in a Deaf Adolescent.pptx

  • 1. COMPLEX PRESENTATION OF SARCOIDOSIS IN A DEAF ADOLESCENT: A CASE STUDY House M.D s05e21- Saviors
  • 2. CASE SUMMARY  Seth, a deaf adolescent with a history of wrestling-related weight cutting and previous tobacco use, presented with a complex array of symptoms including seizures, blindness, post-operative fever, and respiratory distress. Given his inability to communicate verbally, diagnostic evaluation was challenging. Initial differential diagnoses included thrombocythemia, pulmonary embolism, and multiple sclerosis (MS). However, further investigation revealed tobacco stains on Seth's teeth, suggesting a potential link between his past tobacco use and his current condition. Examination of enlarged lymph nodes and clinical observations supported the diagnosis of sarcoidosis, a systemic inflammatory disease characterized by granulomatous inflammation. Treatment with corticosteroids and methotrexate was initiated, leading to symptom improvement and stabilization of Seth's condition. Seth's mother played a crucial role in advocating for his care and facilitating communication with the medical team. Long-term management and monitoring are essential to assess treatment response and disease progression in Seth's case. This case highlights the importance of thorough diagnostic evaluation, effective communication strategies for patients with special needs, and individualized treatment planning in optimizing patient outcomes
  • 3. DIAGNOSIS 1. Medical History and Physical Examination: The healthcare provider will begin by obtaining a detailed medical history, including symptoms, risk factors, and past medical conditions. They will then perform a thorough physical examination to assess for signs of sarcoidosis, such as enlarged lymph nodes, skin lesions, or respiratory symptoms. 2. Laboratory Tests: Blood tests may be ordered to assess for markers of inflammation and organ dysfunction. Common laboratory tests include:  Complete blood count (CBC)  Comprehensive metabolic panel (CMP)  Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)  Serum calcium levels  Liver function tests
  • 4. DIAGNOSIS 3. Imaging Studies: Imaging tests are crucial for evaluating the extent and severity of sarcoidosis involvement in various organs. Common imaging studies include:  Chest X-ray: This may reveal characteristic findings such as bilateral hilar lymphadenopathy and pulmonary infiltrates.  High-resolution computed tomography (HRCT) scan: HRCT provides detailed images of the lungs and is more sensitive than chest X-ray for detecting lung abnormalities.  Magnetic resonance imaging (MRI) or computed tomography (CT) scan: These imaging modalities may be used to assess involvement of other organs such as the heart, liver, spleen, or central nervous system. 4. Pulmonary Function Tests (PFTs): PFTs help assess lung function and detect respiratory impairment, which is common in sarcoidosis. Spirometry, lung volume measurements, and diffusion capacity tests may be performed.
  • 5. DIAGNOSIS 5.Tissue Biopsy: When indicated, a tissue biopsy is often necessary to confirm the diagnosis of sarcoidosis and rule out other conditions with similar presentations. Biopsy samples can be obtained from affected organs, such as the lungs, skin, lymph nodes, or other involved tissues. Histopathological examination of biopsy specimens typically reveals non-caseating granulomas, a hallmark of sarcoidosis. 6.Specialized Tests: In some cases, specialized tests may be performed to assess specific organ involvement or complications of sarcoidosis. These tests may include:  Electrocardiogram (ECG) or echocardiogram: To evaluate cardiac function and detect cardiac manifestations.  Ophthalmic examination: To assess for ocular involvement, such as uveitis or granulomatous inflammation of the eyes.  Neurological tests: To evaluate for central nervous system involvement, which may include imaging studies, lumbar puncture, or nerve conduction studies. 7. Exclusion of Other Conditions: Sarcoidosis is a diagnosis of exclusion, meaning other conditions with similar clinical features must be ruled out. Differential diagnoses may include infections, autoimmune diseases, malignancies, and other granulomatous disorders.
  • 6. TREATMENT  Corticosteroids:  Mechanism of Action: Corticosteroids exert anti-inflammatory and immunosuppressive effects by inhibiting pro-inflammatory cytokines and immune cell activity.  Regular Dosage: Initial dosage typically ranges from 20 to 40 mg/day orally, tapered gradually to the lowest effective maintenance dose.  Potential Adverse Effects: Include adrenal suppression, immunosuppression, metabolic effects (e.g., hyperglycemia), osteoporosis, and gastrointestinal effects.  Methotrexate:  Mechanism of Action: Inhibits dihydrofolate reductase, leading to inhibition of DNA synthesis and cell proliferation.  Regular Dosage: Administered orally or intramuscularly once weekly, with initial dosage of 7.5 to 15 mg/m2.  Potential Adverse Effects: Include hematologic toxicity, hepatotoxicity, gastrointestinal effects, pulmonary toxicity, and renal toxicity.  Other Immunosuppressants:  Azathioprine: Suppresses T-cell and B-cell function, typically administered orally at a starting dosage of 1 to 2 mg/kg/day.  Mycophenolate Mofetil: Inhibits T-cell and B-cell proliferation, administered orally at a dosage of 1 to 1.5 g twice daily.
  • 7. TREATMENT  Biologic Agents:  TNF Inhibitors: Target TNF-alpha, administered via subcutaneous or intravenous routes for severe, refractory sarcoidosis.  Monoclonal Antibodies: Target IL-12 and IL-23, administered via subcutaneous injection for modulating T-cell-mediated immune responses.  Interactions and Precautions:  Drug Interactions: Pharmacists should monitor for interactions with other medications, particularly NSAIDs, anticoagulants, and vaccines.  Contraindications: Active infections, pregnancy, breastfeeding, severe hepatic or renal impairment, and hypersensitivity to medications.  Monitoring: Regular monitoring of complete blood count, liver function tests, renal function tests, and inflammatory markers is essential to assess treatment response and detect adverse effects.
  • 8. CONCLUSION  Regular monitoring of treatment response and adverse effects allows for timely adjustments to therapy and optimization of therapeutic outcomes. Ultimately, a multidisciplinary approach that encompasses the expertise of healthcare professionals, including physicians, nurses, pharmacists, and other allied health professionals, is essential for delivering comprehensive and patient-centered care to individuals with sarcoidosis.