169 Lupus pernio
Salient features
Advanced-level questions
How may sarcoid present?
• Acute sarcoidosis usually presents in the third decade, characterized by erythema nodosum, parotid enlargement and hilar lymphadenopathy.
• Chronic sarcoidosis usually presents in the fifth decade with an insidious onset characterized by fatigue, dyspnoea, arthralgia and lupus pernio. Bone cysts are another feature.
How would you investigate such a patient?
• FBC and ESR: leukopenia, eosinophilia and raised ESR
• Chest radiography. Three stages of sarcoidosis are defined depending on radiographic findings, although these stages do not indicate chronology of disease:
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