Bilateral hilar adenopathy, erythema nodosum, ↑ACE, ↑Ca; young
Most accurate: Biopsy = non-caseating granulomas
Treat: Observe if asymptomatic → Prednisone if organ dysfunction (lung, eye, cardiac, ↑Ca)
Order set
- CXR (hilar nodes)
- Serum ACE, Ca
- Biopsy (non-caseating granuloma)
- PFTs
- ECG (cardiac)
Criteria
AdmitCardiac/neuro involvement or severe hypercalcaemia
DischargeOrgan involvement assessed, therapy if indicated, follow-up
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Cardiac/neuro involvement
- Hypercalcaemia
- Progressive fibrosis
Differentials
- TB
- Lymphoma
- Fungal
- Berylliosis
Common mistakes
- Treating asymptomatic disease
- Missing cardiac sarcoid
Disposition & follow-up
Observe if asymptomatic; steroids for organ involvement.
Discharge package
MedicationsSteroids if organ involvement
Follow-upRespiratory; monitor organs
Warning symptomsBreathlessness, visual/cardiac/neuro symptoms
💊 Treatment detail — doses & preparation
Prednisolonecorticosteroid
DoseSarcoidosis (organ dysfunction): 20–40 mg OD, taper over months per response
Preparation5/25 mg tablets; gastro-resistant or plain with food
MonitorGlucose, BP, mood; bone protection if >3 mo (Ca²⁺/D ± bisphosphonate)
MethotrexateDMARD
Dose10–15 mg PO/SC once weekly, titrate to 20–25 mg weekly + folic acid 5 mg (different day)
Preparation2.5/10 mg tablets — WEEKLY, not daily (dispensing error kills); SC pens 7.5–25 mg
MonitorFBC, LFT, creatinine q2–4 wk until stable; avoid in pregnancy/liver disease
📖 ATS SarcoidosisReviewed July 2026