ATS GUIDELINES Bundle

5 Table 1. Clinical Features Supportive of a Diagnosis of Sarcoidosis Highly Probable Probable History • Löfgren's syndrome a • Seventh cranial nerve paralysis • Treatment-responsive renal failure • Treatment-responsive CM or AVNB • Spontaneous/inducible VT with no risk factors Physical • Lupus pernio • Uveitis • Optic neuritis • Erythema nodosum • Maculopapular, erythematous, or violaceous skin lesions • Subcutaneous nodules • Scleritis • Retinitis • Lacrimal gland swelling • Granulomatous lesions on direct laryngoscopy • Symmetrical parotid enlargement • Hepato-/splenomegaly Imaging • Bilateral hilar adenopathy (CXR, CT, and PET) • Perilymphatic nodules (chest CT) • Gadolinium enhancement on MRI (CNS) • Osteolysis, cysts/punched- out lesion, trabecular pattern bone (X-ray, CT, and MRI) • Parotid uptake (gallium and PET) • Upper lobe or diffuse infiltrates (CXR, CT, and PET) • Peribronchial thickening (CT) • Two or more enlarged extra thoracic nodes (CT, MRI, and PET) • Increased inflammatory activity in heart (MRI, PET, and gallium) • Imaging showing enlargement or nodules in liver or spleen (CT, PET, and MRI) • Inflammatory lesions in bone (gallium, PET, and MRI) Other testing • Hypercalcemia or hypercalciuria with abnormal vitamin metabolism b • Reduced LVEF with no risk factors (echo and MRI) • Elevated ACE level test c • Nephrolithiasis with calcium stone, no vitamin testing • BAL lymphocytosis or elevated CD4:CD8 ratio • Alkaline phosphatase greater than three times the upper limit of normal • New-onset, third-degree AV block in young or middle-aged adults a Löfgren's syndrome is defined as bilateral hilar adenopathy with erythema nodosum and/or periarticular arthritis. b Abnormal vitamin metabolism is defined as normal to low parathyroid hormone, normal to elevated 1,25-dihydroxyvitamin D, and normal to low 25-hydroxyvitamin D. c ACE elevated above 50% of the upper limit of normal was considered abnormal.

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