symptoms of sarcoidosis in the elderly, early symptoms and signs of sarcoidosis in the elderly
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Symptoms of sarcoidosis in the elderly
Early symptoms: Intrapulmonary sarcoidosis usually starts slowly, beginning with chest tightness, shortness of breath, and aggravation of shortness of breath after exercise. There may be a cough, mostly dry cough. Other common systemic symptoms are fatigue, weakness, loss of appetite, joint pain, low fever, etc.
Late-stage symptoms: In late-stage patients, due to granuloma fibrocystic degeneration or bronchiectasis, lung infections may occur repeatedly, resulting in sputum and hemoptysis. 20% of patients with sarcoidosis can involve the eyes and skin. Eye diseases include iridocyclitis, uveitis, conjunctivitis and keratoconjunctivitis, etc.
Related symptoms: Fatigue, nodules, maculopapular rash, low fever, joint pain, subcutaneous nodules, dry cough and congestion
Because of the different organs invaded by the lesions, the manifestations of sarcoidosis are different. More than 90% of sarcoidosis affects the lymph nodes in the lungs and chest cavity. About two-thirds of patients have no clinical symptoms. Even individual patients with bilateral hilar lymphadenopathy with interstitial infiltrates are asymptomatic. Intrapulmonary sarcoidosis usually starts slowly, beginning with chest tightness, shortness of breath, and aggravation of shortness of breath after exercise. There may be a cough, mostly dry cough. Other common systemic symptoms are fatigue, weakness, loss of appetite, joint pain, and low-grade fever. In advanced patients, due to granuloma fibrocystic degeneration or bronchiectasis, lung infections may occur repeatedly, resulting in sputum and hemoptysis. 20% of patients with sarcoidosis can involve the eyes and skin. Eye diseases include iridocyclitis, uveitis, conjunctivitis and keratoconjunctivitis. Skin erythema nodosa is the most common, and chronic patients have maculopapular rash and subcutaneous nodules. A small number of sarcoidosis can have an acute onset, manifested as fever, erythema nodule on the skin of the lower extremities, etc., and severe cases have multiple arthritis, which is called Lofgren syndrome. This syndrome is more common in Europe and the Caucasus, and the prognosis is better. Sarcoidosis often affects the liver, accounting for about 50%, but it is rarely a single organ damage, so the diagnosis is not very difficult. Nervous system involvement and myocardial sarcoidosis are both less than 5%, but the latter can cause arrhythmia, conduction block and congestive heart failure, becoming an important cause of death from sarcoidosis in young people. In patients with sarcoidosis, due to the inflammation of the granuloma in the tissue, the secretion of macrophages and epithelial cells promotes the conversion of vitamin D into activated 1,25-(OH)2 vitamin D, increases the absorption of calcium in the small intestine, and also makes the serum parathyroid hormone. Reduce, cause hypercalcemia and hypercalciuria, hypercalcemia occurs more frequently than hypercalcemia. Kidney stones are the most common manifestation of renal sarcoidosis. According to statistics, hypercalcemia occurs in sarcoidosis in China, and the proportion of hypercalciuria is low.
The diagnosis should be based on clinical manifestations and biohistopathological examination to confirm the formation of non-caseating epithelioid cell granulomas. ① Obtaining bronchial mucosal biopsy specimens through bronchoscopy has a certain positive rate; transbronchial lung biopsy (TBLB) also has a high positive rate. ②Biopsy of swollen superficial lymph nodes can also be diagnosed. If there is no superficial lymph node swelling, a biopsy of the anterior scalene muscle lymph node can be done. ③Kveim skin test is of great significance for diagnosis, but because it is difficult to obtain suitable antigens (spleen or lymph node tissue), and the skin test needs to wait 4-6 weeks before taking a biopsy of the skin nodules, it takes a long time, so It is rarely used in recent years.
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