Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1322 Sarcoidosis Scabies

follow-up

During Treatment

■Assess clinical, biochemical and radiologic activity of disease (com-

mon markers: hypercalcemia, worsening lung function, liver func-

tion tests, ACE, progressive changes on CXR or CT)

complications and prognosis

Complications

■Blindness, pulmonary fibrosis, upper lung cavitations with myce-

toma, cardiac involvement leading to arrhythmias, sudden death,

CHF

Prognosis

■CXR stage as prognostic guide:

➣Stage I: remission of 55–90% of patients

➣Stage II: remission 40–70%

➣Stage III: remission 10–20%

➣Stage IV: remission 0%

➣Lofgren’s syndrome: 90% remission

■>85% of spontaneous remissions occur within 2 y of presentation

■10-fold increase in mortality with cardiac or neurosarcoid

SCABIES

KAREN GOULD, MD

history & physical

History

■close household contacts or sexual partners

■clinical manifestations delayed 3–4 weeks after first exposure

➣symptoms appear earlier with subsequent infestations

■epidemics seen in nursing homes, hospitals

Signs & Symptoms

■pruritic eruption with excoriations

■pruritus worse at night

■lesions often bilateral, usually involving finger web spaces, wrists,

penis

■linear burrows and small erythematous papules seen