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Clinical features supportive of a diagnosis of sarcoidosis

	Highly probable	Probable
History	Löfgren syndrome*	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 Hepatomegaly/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 (radiograph, 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 D metabolism^¶	Reduced LVEF with no risk factors (echo and MRI) Elevated ACE level test^Δ Nephrolithiasis with calcium stone, no vitamin D 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

CM: cardiomyopathy; AVNB: atrioventricular node block; VT: ventricular tachycardia; CXR: chest radiograph; CT: computed tomography; PET: positron emission tomography; MRI: magnetic resonance imaging; CNS: central nervous system; LVEF: left ventricular ejection fraction; ACE: angiotensin-converting enzyme; BAL: bronchoalveolar lavage; AV: atrioventricular.
* Löfgren syndrome is defined as bilateral hilar adenopathy with erythema nodosum and/or periarticular arthritis.
¶ Abnormal vitamin D metabolism is defined as normal to low parathyroid hormone, normal to elevated 1,25-dihydroxyvitamin D, and normal to low 25-hydroxyvitamin D.
Δ ACE elevated above 50% of the upper limit of normal was considered abnormal.

Reprinted with permission of the American Thoracic Society. Copyright © 2020 American Thoracic Society. All rights reserved. Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society.

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