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Investigations

The diagnosis of sarcoidosis is made by the combination of clinical, radiologic, and laboratory findings and confirmed by characteristic histology.[5] Patients with a classic presentation such as Löfgren's syndrome may not need tissue biopsy. However, in all doubtful cases and in cases in which immunosuppressive treatment is likely to be needed, histologic confirmation of one organ is essential. The requirement for more than one organ to be involved to confirm the diagnosis of sarcoidosis does not require a second organ to be sampled. Clinical criteria for organ involvement without a biopsy have been published.[28] Once the diagnosis is established, the American Thoracic Society recommends the comprehensive baseline evaluation listed in Box 164.1.[29]

BOX 164.1 

RECOMMENDED INITIAL EVALUATION IN SARCOIDOSIS

      History of environmental/occupational/medication exposure
      Physical examination
      Chest radiography
      Pulmonary function testing including spirometry and DLco
      Blood cell count
      Serum chemistries (creatinine, calcium, and liver-associated enzymes)
      Creatine kinase level
      Urinalysis
      24-Hour urine collection for determination of calcium and creatinine concentrations
      Electrocardiogram
      Ophthalmologic evaluation including slit lamp examination
      Tuberculin skin test
      Biopsies of affected organs with special stains and cultures
      Other tests depending on organ system presentation

From Statement on Sarcoidosis. Joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999;160:736-755.

Laboratory findings

Laboratory evaluation of patients with sarcoidosis shows many abnormalities.[2],[3]Most patients will have anemia of chronic disease and lymphopenia. Some may have eosinophilia (up to 25%). Leukocyte and platelet …