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Sarcoidosis USMLE Notes & Mnemonics contains all the high-yield points you need to know.

  • Sarcoidosis: A multisystem granulomatous disorder of unknown etiology, characterized by the accumulation of T-lymphocytes and mononuclear phagocytes, noncaseating granulomas in organs.


  • Age: Often presents at <50 years
  • Sex: More common in females
  • Race: Higher prevalence in African Americans and Scandinavians


  • Unknown cause, but immune response to an antigen may be a factor (Ref)
  • Possible environmental triggers in genetically predisposed individuals


  • Formation of noncaseating granulomas in multiple organs
  • CD4+ T-helper cells play a central role
  • ACE level elevation: Due to production by epithelioid cells of granulomas

Clinical Features

  • Lungs: Dyspnea, cough
  • Skin: Lupus pernio, erythema nodosum
  • Eyes: Uveitis, conjunctivitis
  • Lymphatic: Bilateral hilar lymphadenopathy
  • MSK: Arthritis, arthralgia
  • Heart: Conduction abnormalities, cardiomyopathy
  • CNS: Cranial nerve palsies, especially facial nerve
  • Hypercalcemia: Due to 1-alpha-hydroxylase mediated vitamin D conversion in macrophages

Mnemonic for Symptoms: “GRUELING

  • G = Granulomas (noncaseating)
  • R = Rheumatological (arthralgias, arthritis)
  • U = Uveitis
  • E = Erythema nodosum
  • L = Lymphadenopathy (bilateral hilar)
  • I = Interstitial lung disease
  • N = Neurological (cranial nerve palsies)
  • G = Gammaglobulinemia (hypergammaglobulinemia)


  • Chest X-Ray: Bilateral hilar lymphadenopathy, reticular opacities
  • CT Scan: Assess for pulmonary fibrosis, nodules, ground-glass opacities
  • Pulmonary function tests: Restrictive pattern, reduced diffusing capacity
  • Serum ACE levels: Elevated, nonspecific
  • Serum calcium: Hypercalcemia due to vitamin D activation by macrophages
  • Biopsy: Noncaseating granulomas without central necrosis
  • Bronchoalveolar lavage: Increased CD4/CD8 ratio


  • Asymptomatic: Observation
  • Symptomatic: Glucocorticoids (first-line)
  • Severe or refractory disease: Methotrexate, azathioprine, infliximab


  • Pulmonary: Fibrosis, pulmonary hypertension
  • Cardiac: Arrhythmias, heart failure
  • Neurological: Seizures, neuropathy
  • Ophthalmologic: Blindness


  • Varies widely: many have spontaneous remission, others have chronic disease
  • Prognostic factors: Acute presentation like Lofgren syndrome (erythema nodosum, fever, bilateral hilar lymphadenopathy, and polyarthralgia) has a good prognosis

Mnemonic for Prognosis: “PHACE

  • P = Pulmonary involvement severity
  • H = Heart complications
  • A = Ace levels (correlate poorly with disease activity)
  • C = Calcium levels (hypercalcemia can worsen prognosis)
  • E = Eye involvement

Note: This notes format is designed for quick review before USMLE exams; understanding pathophysiology and integrating clinical scenarios is essential for success. Always cross-reference with the latest guidelines and evidence.

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