History and exam

Key diagnostic factors

common

cough

Nonproductive.

dyspnea

Usually gradual in onset.

May worsen with disease progression.

chronic fatigue

Fatigue is an under-recognized symptom in sarcoidosis and is difficult to treat.[30]​​[54]

If fatigue is out of proportion to pulmonary involvement, as assessed by imaging and/or pulmonary function tests, pulmonary arterial hypertension or congestive heart failure should be considered.

arthralgia

Pain in knees, ankles, and wrists.[36][37]

No synovial thickening on examination.

wheezing

Bronchospasm, due to airway hyperreactivity.

rhonchi

Bronchospasm, due to airway hyperreactivity.

lymphadenopathy

Nodes are enlarged and nontender.

Cervical, submandibular nodes are often involved.

photophobia

Usually indicates uveitis.

red painful eye

Symptom of uveitis.

May be associated with superficial punctate keratitis.

blurred vision

Symptom of uveitis.

May be associated with superficial punctate keratitis

uncommon

erythema nodosum

Tender erythematous nodules on the lower extremities.

Predictor of good prognosis.

lupus pernio

Indurated plaques with discoloration of the nose, cheeks, lips, and ears.

More common in people from Puerto Rico.[14]

Predictor of poor prognosis.[14]​​

conjunctival nodules

With ocular involvement.

facial palsy

May be a presenting symptom/sign.

When facial palsy occurs with uveoparotid fever (uveitis/parotitis/facial palsy), prognosis is relatively good.

Other diagnostic factors

common

absent history of exposure to beryllium

If there is a history of exposure to beryllium, possibly through occupational exposure in the aerospace or nuclear industries, it is important to consider the diagnosis of berylliosis, as this can mimic the signs and symptoms of sarcoidosis.[31]

uncommon

chest wall pain

Worsens with respirations.

Tenderness at the costochondral junctions, indicating costochondritis.

hemoptysis

An uncommon presentation in early sarcoidosis. When it is the initial manifestation of sarcoidosis, endobronchial involvement is usually present. Hemoptysis is rarely massive or life-threatening, except when associated with mycetomas in radiographic stage IV disease.[55]

weight loss

Unexplained modest weight loss.

Can be mistaken for weight loss due to tuberculosis or lymphoma when associated with an abnormal chest x-ray.

low-grade fever

Can be mistaken for fever due to tuberculosis or lymphoma when associated with an abnormal chest radiograph.

arrhythmias

Atrial or ventricular.

heart block

May rarely be the initial presentation.

hepatomegaly

Nontender.

headache

May be a sign of neurosarcoidosis.

seizures

May be a sign of neurosarcoidosis.

symptoms and signs of pituitary lesion

Rarely occurs (e.g., diabetes insipidus). Symptoms of a pituitary lesion include headache, loss of vision, double vision, nausea, and vomiting; signs include poor peripheral vision, signs of hypopituitarism such as hypogonadism, hypoadrenalism, hypothyroidism, and growth hormone deficiency.

Risk factors

strong

age 20-50 years

Initial presentation most common in this age range; some data suggest that the age at onset is increasing.​​[8][9][12][14]

family history of sarcoidosis

A significantly elevated risk of sarcoidosis has been observed among first- and second-degree relatives of patients with sarcoidosis.[19][20][21]​​

Scandinavian origin

Higher incidence in people of Scandinavian origin.​[8][9][14]

weak

female sex

Some studies report a female preponderance, while others report no sex difference.[14][22][23][24][25]​​​

nonsmokers

Appears to occur more commonly in nonsmokers than in smokers.[26][27]

black ancestry

The lifetime risk of sarcoidosis for black people is slightly higher than for white people in the US.[14][28]​​ Age-adjusted mortality rate for African-Americans is higher than for white people.​[29]​​

black ancestry: uveitis

Chronic uveitis is more common in black people in the US.[14]

Puerto Rican origin: lupus pernio

Lupus pernio is more common in people from Puerto Rico.[14]

European origin: erythema nodosum

Erythema nodosum is more common in Europeans.[14]

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