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Sarcoidosis diagnosis without biopsy



I am 30. After some enlarged lymph nodes were spotted on a CT scan I was referred to a pulmonologist who ordered a galium scam and a ACE blood test. My ACE level was 81 and my galium scan showed enlarged lymph nodes all over my body but predominently in my spleen, nasal and eye area, groin, and right thigh. He also did a pulmonary function test that was good and a TB test that was negative. From these test he concluded that I have sarcoidosis and put me on 10 mg os prednisone a day. I am concerned because he did not do a biopsy but he said one was not needed because he could tell from the other tests that it was not lymphoma. Does that make sense? DO I need a biopsy? My symptoms are joint and muscle pain, extreme fatigue, sweating of the face and neck for no reason, off and on low grade fever, shaky hands, loss of appetite and general bad feeling.


Dear Sir/Madam- According to the consensus of an assembly of sarcoidosis experts (i.e., the World Association of Sarcoidosis and Other Granulomatous Diseases), the definitive diagnosis of sarcoidosis requires at least one confirmatory biopsy. That being said, some patients present with a very characteristic clinical syndrome that is very typical of sarcoidosis and the doctor may elect to treat empirically (without tissue confirmation).

Your clinical presentation certainly could be caused by sarcoidosis. However, the widespread nature of the lymph node enlargement and the incomplete response to prednisone with ongoing symptoms is concerning for other possibilities (e.g., infection or lymphoma). Furthermore, you are concerned enough to ask me if you might have something other than sarcoidosis. Taken together, a biopsy of one of the affected lymph nodes would make sense.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University