Summary
Definition
History and exam
Key diagnostic factors
- cough
- dyspnea
- chronic fatigue
- arthralgia
- wheezing
- rhonchi
- lymphadenopathy
- photophobia
- red painful eye
- blurred vision
- erythema nodosum
- lupus pernio
- 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 20-50 years
- family history of sarcoidosis
- Scandinavian origin
- female sex
- nonsmokers
- black ancestry
- black ancestry: uveitis
- Puerto Rican origin: lupus pernio
- European origin: erythema nodosum
Diagnostic tests
1st tests to order
- chest x-ray
- CBC
- serum BUN
- serum creatinine
- liver enzymes
- serum calcium
- PFTs
- ECG
- eye exam
- interferon gamma release assay
Tests 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
Emerging tests
- 3'-deoxy-3'-[18F]-fluorothymidine (FLT) PET scan
- 4'-[methyl-11C]-thiothymidine PET/CT scan
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
Acting Chief of Pulmonary, Critical Care & Sleep Medicine
VA Medical Center, Memphis
Professor & Vice Chair of Medicine
University of Tennessee Health Science Center
Memphis
TN
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
WV
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
IL
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
NY
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
IL
Disclosures
NS declares that she has no competing interests.
References
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
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- Histoplasmosis
- Non-small cell lung cancer
More DifferentialsGuidelines
- Diagnosis and management of cardiac sarcoidosis: a scientific statement from the American Heart Association
- ERS clinical practice guidelines on treatment of sarcoidosis
More GuidelinesPatient information
Sarcoidosis
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