Sarcoidosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 6 Aug 2025

Last updated: 01 Apr 2025

Sarcoidosis is a diagnosis of exclusion of granulomatous lung diseases, including tuberculosis and histoplasmosis.

Typical history is essential to establish the diagnosis, and biopsy from affected organs is often required.

Treated with topical corticosteroids for mild local cutaneous disease. Systemic corticosteroids are the mainstay of treatment for severe disease. Immunomodulatory therapies are corticosteroid-sparing and can be used in the treatment of corticosteroid-refractory disease.

Poorer prognosis if black ancestry, chronic pulmonary involvement, lupus pernio, or chronic hypercalcaemia.

Spontaneous remissions occur in 55% to 90% of patients with stage I, 40% to 70% of patients with stage II, and about 20% of patients with stage III disease. Remission is not expected in patients with stage IV disease.

Definition

Sarcoidosis is a chronic granulomatous disorder of unknown aetiology, commonly affecting the lungs, skin, and eyes. It is characterised by accumulation of lymphocytes and macrophages and the formation of non-caseating granulomas in the lungs and other organs. Although lungs and lymph nodes are involved in more than 90% of patients, virtually any organ can be involved.[1] The clinical course is often heterogeneous and unpredictable.

History and exam

Key diagnostic factors

presence of risk factors
cough
dyspnoea
chronic fatigue
arthralgia
wheezing
rhonchi
lymphadenopathy
photophobia
red painful eye
blurred vision
erythema nodosum
lupus pernio
conjunctival nodules
facial palsy

Full details

Other diagnostic factors

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

Full details

Risk factors

age 20-50 years
family history of sarcoidosis
Scandinavian origin
female sex
non-smokers
black ancestry
black ancestry: uveitis
Puerto Rican origin: lupus pernio
European origin: erythema nodosum

Full details

Diagnostic investigations

1st investigations to order

chest x-ray
FBC
serum urea
serum creatinine
liver enzymes
serum calcium
PFTs
ECG
eye examination
interferon gamma release assay

Full details

Investigations to consider

serum ACE
CT scan of chest
endobronchial ultrasound-transbronchial needle aspiration
bronchoalveolar lavage (BAL)
skin biopsy
24-hour urine calcium
gallium-67 scan
vitamin D
MRI
(18)F-fluorodeoxyglucose (FDG) PET scan

Full details

Emerging tests

3'-deoxy-3'-[18F]-fluorothymidine (FLT) PET scan
4'-[methyl-11C]-thiothymidine PET/CT scan

Treatment algorithm

ACUTE

acute respiratory failure unable to tolerate oral intake

acute respiratory failure able to tolerate oral intake

ONGOING

pulmonary disease

cutaneous disease

ocular disease

cardiovascular disease

central nervous system or peripheral nervous system involvement

renal disease

Contributors

Authors

Muthiah P. Muthiah, MD, FCCP

Acting Chief of Pulmonary, Critical Care & Sleep Medicine

VA Medical Center, Memphis

Professor & Vice Chair of Medicine

University of Tennessee Health Science Center

Memphis

Disclosures

MPM declares that he has no competing interests.

Amr El Gamal, MD, FCCP

Pulmonary and Critical Care

Medical Service

VA Medical Center

Martinsburg

Assistant Professor of Medicine

West Virginia University

Morgantown

Disclosures

AEG declares that he has served as a reviewer for the American Physician Institute.

Peer reviewers

George Swingler, MD

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.

Kyle Hogarth, MD, FCCP

Assistant Professor of Medicine

Department of Medicine

Section of Pulmonary and Critical Care

University of Chicago

Chicago

Disclosures

KH declares that he has no competing interests.

Marc Judson, MD

Chief

Division of Pulmonary and Critical Care Medicine

AMC Pulmonary and Critical Care Medicine

Albany

Disclosures

MJ declares that he has no competing interests.

Nadera Sweiss, MD

Assistant Professor of Medicine

Section of Rheumatology

Department of Medicine

University of Chicago

Chicago

Disclosures

NS declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Thoracic Society. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999 Aug;160(2):736-55.Full text Abstract

Thillai M, Atkins CP, Crawshaw A, et al. BTS clinical statement on pulmonary sarcoidosis. Thorax. 2021 Jan;76(1):4-20.Full text Abstract

Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and detection of sarcoidosis. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020 Apr 15;201(8):e26-51.Full text Abstract

Cheng RK, Kittleson MM, Beavers CJ, et al. Diagnosis and management of cardiac sarcoidosis: a scientific statement from the American Heart Association. Circulation. 2024 May 21;149(21):e1197-216.Full text Abstract

Baughman RP, Valeyre D, Korsten P, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021 Dec;58(6):2004079.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Tuberculosis
- Histoplasmosis
- Non-small cell lung cancer
More Differentials
Guidelines
- Diagnosis and management of cardiac sarcoidosis: a scientific statement from the American Heart Association
- ERS clinical practice guidelines on treatment of sarcoidosis
More Guidelines
Patient information
Sarcoidosis
More Patient information
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Sarcoidosis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

acute respiratory failure unable to tolerate oral intake

acute respiratory failure able to tolerate oral intake

pulmonary disease

cutaneous disease

ocular disease

cardiovascular disease

central nervous system or peripheral nervous system involvement

renal disease

Contributors

Authors

Muthiah P. Muthiah, MD, FCCP

Disclosures

Amr El Gamal, MD, FCCP

Disclosures

Peer reviewers

George Swingler, MD

Disclosures

Kyle Hogarth, MD, FCCP

Disclosures

Marc Judson, MD

Disclosures

Nadera Sweiss, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice