Adults
Sarcoidosis with rheumatologic features
Hilar lymphadenopathy with arthritis or erythema nodosum (Löfgren), uveitis, skin or multi-organ disease.
What to look for
- Löfgren syndrome: bilateral hilar lymphadenopathy, erythema nodosum and ankle periarthritis
- Chronic arthritis, lupus pernio, uveitis, hypercalcemia
- Cardiac or neurologic involvement
What to do
- Get a chest X-ray or CT. Send calcium, CBC, metabolic panel with liver tests, and urinalysis.
- ACE level has limited sensitivity and specificity.
- Biopsy accessible tissue to look for non-caseating granulomas, except in classic Löfgren.
- Arrange an eye exam. Coordinate with pulmonology. Suspected cardiac sarcoid is urgent; syncope, high-grade heart block or sustained ventricular arrhythmia is an emergency.
About this urgency level
Specialist evaluation helps, but these are usually less time-sensitive than new inflammatory arthritis or connective tissue disease.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.