sarcoidosis labs and diagnosis
- related: pulmonary and extrapulmonary sarcoidosis
- tags: #permanent #pulmonology
Labs
- elevated inflammatory markers: ESR
- hypercalcemia with hypercalciuria
- elevated ACE level can suggest sarcoidosis
- Increased levels of vitamin D (macrophages inside the granulomas convert vitamin D to its active form.)
- can have interstitial nephritis
- increased gammaglobulins 1
- Elevated alkaline phosphatase if there is liver involvement
- Heart block: 3rd degree (most common) or 1st degree
- look for new onset AV block in young patients 2
- Ventricular arrhythmia: sustained or nonsustained ventricular tachycardia and ventricular premature beats
Diagnosis
- lymph node biopsy demonstrates non-caseating granulomas
- tissue diagnosis with noncaseating granuloma is required except in lofgren syndrome (lofgren syndrome is sarcoidosis with constitution of symptoms), lupus pernio (lupus pernio is sarcoid skin problem and not related to lupus), Heerfordt's syndrome2
- rule out other causes of noncaseating granuloma
- biopsy of erythema nodosum does not show granulomas in sarcoid patients
- However, in OPPM sarcoidosis, skin biopsy was recommended to be easiest biopsy option
- other biopsy options: peripheral lymph nodes, conjunctiva
- mediastinoscopy