Sarcoidosis

Last reviewed: 25 Apr 2022
Last updated: 19 Mar 2018

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
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • CXR
  • CBC
  • serum BUN
  • creatinine
  • liver enzymes
  • serum calcium
  • PFTs
  • ECG
  • purified protein derivative of tuberculin (PPD)
More 1st investigations to order

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
More investigations to consider

Emerging tests

  • MRI
  • (18)F-fluorodeoxyglucose (FDG) PET 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

CNS, peripheral nervous system, or cardiovascular involvement

Contributors

Authors

Muthiah P. Muthiah, MD, FCCP

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.

Amr El Gamal, MD, FCCP

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

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.

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