Sarcoidosis differential diagnosis: Difference between revisions
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# '''Medical history''' | # '''Medical history''' | ||
## [[Non-smoker]] | ## [[Non-smoker]] | ||
## No symptoms(in patient with [[bilateral hilar adenopathy]] on [[CXR]]) | ## No symptoms (in patient with [[bilateral hilar adenopathy]] on [[CXR]]) | ||
## Family history of [[sarcoidosis]] | ## Family history of [[sarcoidosis]] | ||
## Symptoms involving more than two organs commonly involved by [[sarcoidosis]] | ## Symptoms involving more than two organs commonly involved by [[sarcoidosis]] | ||
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# '''Radiographic findings''' | # '''Radiographic findings''' | ||
## [[CXR]]: | ## [[CXR]]: | ||
###[[bilateral hilar adenopathy]] especially if '''without''' symptoms | ###[[bilateral hilar adenopathy]] especially if '''without''' symptoms | ||
### Upper lobe disease | ### Upper lobe disease | ||
## [[HRCT]]: | ## [[HRCT]]: | ||
Revision as of 15:34, 10 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.
Overview
Sarcoidosis has many differentials, which can be classified depending on the organ involved, pathologic findings and laboratory findings.
Differential Diagnosis
Sarcoidosis has been defined as a multisystem granulomatous disorder of unknown cause[1], but granulomatous inflammation alone is not sufficient for the diagnosis of sarcoidosis because alternative etiologies of granulomatous inflammation need to be excluded.
Causes of granulomatous reaction beside sarcoidosis
- Mycobacterium tuberculosis
- Mycoplasma
- Pneumocystis jiroveci
- Brucellosis
- Cat-scratch fever
- Atypical mycobacteria
- Toxoplasmosis
- Berylliosis
- Hard metal
- Zirconium
- Tattoo
- Hypersensitivity pneumonitis
- Medications (e.g., methotrexate)
- ANCA-associated vasculitis
- Necrotizing sarcoid granuloma
- Lymphoma
- Cancer
- Granulomatous lesions of unknown significance
- Crohn’s disease
- Lymphocytic interstitial pneumonia
- Behçet’s disease
- Rheumatoid nodules[1]
Data supporting the likelihood of sarcoidosis
- Demographics
- Medical history
- Non-smoker
- No symptoms (in patient with bilateral hilar adenopathy on CXR)
- Family history of sarcoidosis
- Symptoms involving more than two organs commonly involved by sarcoidosis
- Laboratory data
- Elevated ACE level (especially if > 2× ULN)
- Elevated calcium level
- Elevated alkaline phosphatase level
- Elevated soluble IL-2 receptor
- Leukopenia
- Radiographic findings
- CXR:
- bilateral hilar adenopathy especially if without symptoms
- Upper lobe disease
- HRCT:
- Disease along bronchovascular bundle
- Subpleural reticulonodular infiltrates
- Mediastinal adenopathy
- Peribronchial thickening
- Traction bronchiectasis of upper lobe
- CXR:
- Skin lesions
- Lupus pernio
- Erythema nodosum
- Maculopapular lesions
- Ocular disease
- Neurological disease
- Renal disease
Data weakening the likelihood of sarcoidosis
- Demographics
- Age< 18 years
- Medical history
- Exposure to tuberculosis
- Exposure to organic bioaerosol
- Exposure to beryllium
- Intravenous drug abuse
- Laboratory data
- Positive anti-neutrophil cytoplasm antibody (ANCA)
- Radiographic findings
- CXR:
- HRCT:
- Subpleural honeycombing
- Ocular disease
- Renal disease
References
- ↑ 1.0 1.1 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 160:736–755, 1999.
- ↑ 2.0 2.1 Judson MA: The diagnosis of sarcoidosis. Clin Chest Med 29(3):415–427, 2008.