Table 1

Extrapulmonary manifestations of sarcoidosis and appropriate investigations

Organ systemPrevalenceManifestationsInvestigations
SystemicFatigue, malaise, weight loss, feverSerum inflammatory markers, serum ACE
Ocular20–50%Uveitis, conjunctivitis, nodules, optic neuritisOphthalmological assessment, Gallium scan (rare)
Cardiac5–25%Heart block, dysrhythmias, heart failure, valvular dysfunction, pericardial disease, sudden deathElectrocardiography, echocardiography, Holter monitoring, cardiac MRI
Renal and endocrine2–10%Hypercalcaemia and hypercalciuria, interstitial nephritis, nephrolithiasis, nephrocalcinosis, hormonal dysfunctionRenal function testing (serum electrolytes, urea, creatinine), serum calcium, serum vitamin D, ultrasonography, hormone studies
Cutaneous/lymphoid25%Erythema nodosum, lupus pernio, nonspecific patterns (e.g. papular, nodular, plaque-like), palpable lymphadenopathyBiopsy as needed, skin lesions can often be clinically diagnosed
Musculoskeletal25–39%Arthropathy, myopathy, bony lesionsSerum creatinine kinase, radiographs, CT, MRI, PET, muscle biopsy
Nervous system10%Headaches, cranial nerve palsies, cognitive and psychiatric dysfunction, small fibre neuropathy, seizures, spinal neuropathyBrain and spine MRI, CSF analysis, electromyography, nerve conduction studies
Liver and spleen30–80%Hepatomegaly, splenomegaly, nonspecific liver function and enzyme derangementLiver function testing, abdominal ultrasound and CT, liver biopsy if significant laboratory derangement
Haematological4–40%Anaemia, leukopeniaFull blood count with differential, bone marrow biopsy (rare)

Pulmonary manifestations are not included. ACE: angiotensin converting enzyme; CT: computed tomography; MRI: magnetic resonance imaging; PET: positron emission tomography; CSF: cerebrospinal fluid. Data from [3, 4, 8, 38, 44, 45].