Abstract
Mrs G is a 47-year-old lady who is an infrequent attender at the GP surgery. She presents with a 4-month history of extreme tiredness and lethargy. She is a non-smoker, drinks very little alcohol and has no past medical history of note.
1. What might be the cause of Mrs G’s tiredness? 2. What investigations might you perform?
Mrs G has a blood screen done including full blood count, liver and renal function and thyroid function tests, fasting glucose, erythrocyte sedimentation rate and C-reactive protein, coeliac screen and serum iron. All the results are normal. Urine dipstick is also normal. She has an appointment to come back for review, but before she is reviewed you receive a letter from the local eye hospital saying that Mrs G has attended with an acute red eye thought to be caused by acute anterior uveitis and recommending further investigation for an underlying cause.
3. What are the possible underlying causes of acute uveitis and how might you investigate this further?
Further investigations are all negative. However, Mrs G has noticed an odd skin lesion that has arisen on the top of her leg. You examine it and refer her to a GP colleague within your own practice who has a special interest in dermatology. She biopsies the lesion and the histology comes back suggestive of sarcoid.
4. What are the possible symptoms of sarcoid? 5. How might Mrs G be managed further?