Pediatric Sarcoidosis Differential Diagnoses

  • Author: Girish D Sharma, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Dec 1, 2011
 
 

Diagnostic Considerations

The differential diagnosis of sarcoidosis depends largely on the clinical presentation of the disease. Rule out granulomatous pulmonary infections, especially those caused by mycobacteria and fungi. Exclude neoplastic diseases, such as lymphoma, in cases with hilar adenopathy. Hypercalcemia in sarcoidosis may mimic metabolic disorders, such as primary hyperparathyroidism. Early onset sarcoidosis is often misdiagnosed as systemic-onset JRA.[15] Rarely, severe symptomatic bone marrow involvement may mimic numerous infectious and neoplastic disorders.

Differentials

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Girish D Sharma, MD  Associate Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Charles Callahan, DO Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Abraham Gedalia, MD Head, Division of Pediatric Rheumatology, Professor of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans

Abraham Gedalia, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Rheumatology

Disclosure: Nothing to disclose.

Susanna A McColley, MD Professor of Pediatrics, Northwestern University, The Feinberg School of Medicine; Director of Cystic Fibrosis Center, Head, Division of Pulmonary Medicine, Children's Memorial Medical Center of Chicago

Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, and American Thoracic Society

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Honoraria Consulting; Boston Scientific Consulting fee Consulting; Gilead Honoraria Speaking and teaching; Caremark Consulting fee Consulting; Vertex Pharmaceuticals Honoraria Speaking and teaching

Avinash Shetty, MD Department of Pediatrics, Division of Pediatric Infectious Diseases, Assistant Professor of Pediatrics, Wake Forest University School of Medicine

Avinash Shetty, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

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  2. Valetonyte R, Hampe J, Huse K et al. Sarcoidosis is associated with a truncating splice site mutation in BTNL2. Nat Genet. 2005;37:357-64.

  3. Rybicki BA, Walewski JL, Maliarik MJ, Kian H, Iannuzzi MC,. The BTNL2 gene and sarcoidosis susceptibility in African Americans and Whites. Am J Hum Genet. Sep 2005;77(3):491-9. [Medline].

  4. Braun T, Siedek V, Assmann G, et al. [Sarcoidosis of lymph nodes in the submandibular compartment.]. HNO. Jul 1 2009;[Medline].

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  14. Hetherington S. Sarcoidosis in young children. Am J Dis Child. Jan 1982;136(1):13-5. [Medline].

  15. Ukae S, Tsutsumi H, Adachi N, Takahashi H, Kato F, Chiba S. Preschool sarcoidosis manifesting as juvenile rheumatoid arthritis: a case report and a review of the literature of Japanese cases. Acta Paediatr Jpn. Oct 1994;36(5):515-8. [Medline].

  16. [Guideline] Society of Nuclear Medicine. Procedure guideline for gallium scintigraphy in inflammation. Society of Nuclear Medicine. Jun 2004.

  17. Harada T, Nabeshima K, Matsumoto T, Akagi T, Fujita M, Watanabe K. Histological findings of the computed tomography halo in pulmonary sarcoidosis. Eur Respir J. Jul 2009;34(1):281-3. [Medline].

  18. Heyer CM, Lemburg SP, Kagel T, Mueller KM, Nuesslein TG, Rieger CH, et al. Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy. Eur Radiol. Jul 2005;15(7):1289-95. [Medline].

  19. Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. Am J Med Sci. Mar 1990;299(3):153-7. [Medline].

  20. Gedalia A, Molina JF, Ellis GS Jr, et al. Low-dose methotrexate therapy for childhood sarcoidosis. J Pediatr. Jan 1997;130(1):25-9. [Medline].

  21. Alhamad EH. The six-minute walk test in patients with pulmonary sarcoidosis. Ann Thorac Med. Apr 2009;4(2):60-4. [Medline].

 
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Chest radiograph showing bilateral hilar lymphadenopathy in a 10-year-old girl with sarcoidosis.
Chest radiograph showing patchy diffuse pulmonary infiltrates involving both lung fields in a 12-year-old girl at onset of her sarcoidosis (left). A repeated study 6 months later showing almost complete resolution of the infiltrates (right).
 
 
 
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