Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • dyspnea
  • erythema nodosum
  • lupus pernio
  • chronic fatigue
  • arthralgia
  • wheezing
  • rhonchi
  • lymphadenopathy
  • photophobia
  • red painful eye
  • blurred vision
  • conjunctival nodules
  • facial palsy

Other diagnostic factors

  • absent history of exposure to beryllium
  • chest wall pain
  • hemoptysis
  • weight loss
  • low-grade fever
  • arrhythmias
  • heart block
  • hepatomegaly
  • headache
  • seizures
  • symptoms and signs of pituitary lesion

Risk factors

  • age 20-40 years
  • FHx sarcoidosis
  • female gender
  • nonsmokers
  • black ancestry (US): uveitis
  • Scandinavian origin
  • Puerto Rican origin: lupus pernio
  • European origin: erythema nodosum

Diagnostic investigations

1st investigations to order

  • CXR
  • CBC
  • serum BUN
  • creatinine
  • liver enzymes
  • serum calcium
  • PFTs
  • ECG
  • purified protein derivative of tuberculin (PPD)
Full details

Investigations to consider

  • CT scan of chest
  • flexible bronchoscopy with transbronchial lung biopsy
  • bronchoalveolar lavage (BAL)
  • skin biopsy
  • 24-hour urine calcium
  • serum ACE
  • gallium-67 scan
  • endobronchial ultrasound-transbronchial needle aspiration
Full details

Emerging tests

  • MRI
  • (18)F-fluorodeoxyglucose (FDG) PET scan
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Medicine

Division of Pulmonary and Critical Care and Sleep Medicine

Director

Pulmonary and Critical Care Medicine Fellowship Program

University of Tennessee

Memphis

TN

Disclosures

MPM declares that he has no competing interests.

Pulmonary and Critical Care

Medical Service

VA Medical Centre

Martinsburg

Assistant Professor of Medicine

West Virginia University

Morgantown

WV

Disclosures

AEG declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor

School of Child and Adolescent Health

Red Cross Children's Hospital

University of Cape Town

Rondebosch

Cape Town

South Africa

Disclosures

GS declares that he has no competing interests.

Assistant Professor of Medicine

Department of Medicine

Section of Pulmonary and Critical Care

University of Chicago

Chicago

IL

Disclosures

KH declares that he has no competing interests.

Chief

Division of Pulmonary and Critical Care Medicine

AMC Pulmonary and Critical Care Medicine

Albany

NY

Disclosures

MJ declares that he has no competing interests.

Assistant Professor of Medicine

Section of Rheumatology

Department of Medicine

University of Chicago

Chicago

IL

Disclosures

NS declares that she has no competing interests.

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