Diagnostic approach if suspected sarcoidosis

Due to the non specific presentation, diagnosis of the disease is challenging and may be delayed even by the most experienced clinicians.

A delay in diagnosis can be observed in patients with pulmonary disease while those with a dermatological presentation a diagnosis is made with less delay (1).

The diagnosis of sarcoidosis should be made in the presence of compatible clinical and radiological findings, supporting histological evidence of noncaseating granuloma in tissue biopsy and after exclusion of other known causes of granuloma formation (2,3)

Clinicoradiologic findings or the presence of granulomas in the tissue biopsy alone is not sufficient for the diagnosis of sarcoidosis (3)

A diagnosis of sarcoidosis can be reasonably assumed in patients with the following clinical presentation without tissue conformation (when additional data does not suggest an alternative diagnosis) (2)

• Lofgren's syndrome
• Herfort's syndrome
• bilateral hilar adenopathy on chest radiograph without symptoms
• positive Panda sign (parotid and lacrimal gland uptake) and Lambda sign (bilateral hilar and right paratracheal scan (3)

Reference:

• 1. Wu JJ, Schiff KR. Sarcoidosis. Am Fam Physician. 2004;70(2):312-22.
• 2. Iannuzzi MC, Fontana JR. Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics. JAMA. 2011;305(4):391-9
• 3. Judson MA. The diagnosis of sarcoidosis. Clin Chest Med. 2008;29(3):415-27