Sarcoidosis differential diagnosis

Sarcoidosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Sarcoidosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Sarcoidosis differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sarcoidosis differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sarcoidosis differential diagnosis
CDC on Sarcoidosis differential diagnosis
Sarcoidosis differential diagnosis in the news
Blogs on Sarcoidosis differential diagnosis
Directions to Hospitals Treating Sarcoidosis
Risk calculators and risk factors for Sarcoidosis differential diagnosis

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, 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

Data supporting the likelihood of sarcoidosis

1. Demographics
   1. U.S. African American
   2. Northern European
2. Medical history
   1. Non-smoker
   2. No symptoms(in patient with bilateral hilar adenopathy on CXR)
   3. Family history of sarcoidosis
   4. Symptoms involving more than two organs commonly involved by sarcoidosis
3. Laboratory data
   1. Elevated ACE level (especially if > 2× ULN)
   2. Elevated calcium level
   3. Elevated alkaline phosphatase level
   4. Elevated soluble IL-2 receptor
   5. Leukopenia
4. Radiographic findings
   1. CXR:
      1. bilateral hilar adenopathy especially if without symptoms)
      2. Upper lobe disease
   2. HRCT:
      1. Disease along bronchovascular bundle
      2. Subpleural reticulonodular infiltrates
      3. Mediastinal adenopathy
      4. Peribronchial thickening
      5. Traction bronchiectasis of upper lobe
5. Skin lesions
   1. Lupus pernio
   2. Erythema nodosum
   3. Maculopapular lesions
6. Ocular disease
   1. Uveitis
   2. Optic neuritis
7. Neurological disease
   1. Seventh cranial nerve palsy
8. Renal disease
   1. Nephrocalcinosis
   2. Interstitial nephritis