Sarcoidosis

Introduction to sarcoidosis Sarcoidosis is a multi-system granulomatous disease of unknown etiology. It is clinically characterized by bilateral hilar lymphadenopathy, pulmonary infiltration and skin and eye damage. Granuloma nodules can invade all organs of the body. Common in young adults, more than 90% of the patients have lung changes, characterized by double hilar lymphadenopathy, lung infiltration, eye and skin damage. Liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles, bones and other organs can also be affected. Diagnosis can be made with typical clinical and X-ray findings, as well as histologically non-cheed epidermoid cell granulomas, except for other granulomatous diseases. The immunological characteristics of the disease are inhibition of skin allergic-like allergic reactions and enhancement of type I helper T cell (TH1) immune response, as well as increased circulating immune complexes and B-cell responses. basic knowledge The proportion of illness: 0.006% Susceptible people: no specific population Mode of infection: non-infectious Complications: respiratory failure, pulmonary heart disease

Cause of sarcoidosis

Immunity factor (75%):

In recent years, this disease is thought to be related to the immune response. In particular, T cell-mediated immune responses play an important role. T cells and macrophages at the lesion site are activated by stimulation of certain pathogenic antigens. Activated T cells release a large number of monocyte chemotactic factors and macrophage migration inhibitors, causing mononuclear cells to aggregate; activated macrophages release interleukin-1, causing T cell division and proliferation, Early lesions are mainly infiltrated by T cell monocytes and macrophages. As the disease progresses, epithelioid cells are produced in large quantities, forming a typical nodular granuloma. In the later stages of the disease, fibroblasts proliferate and eventually become extensively fibrotic.

Other factors (2%):

Some scholars have suggested that the disease may also be affected by other factors, such as viral infection and genetic factors, but it has not been confirmed.

Sarcoidosis prevention

1. The cause of sarcoidosis is unknown. Therefore, effective preventive measures must be explored. However, adrenocortical hormone is still the drug of choice at present, and reducing the dose without affecting treatment can greatly reduce the incidence of opportunistic infection.

2. Diabetic patients may be exacerbated by hormones and should be used with caution.

Sarcoidic complications Complications, respiratory failure, pulmonary heart disease

Sarcoidosis with pleural lesions is not uncommon. It is particularly pointed out that kidney and liver damage or cardiac abnormalities may be caused by common comorbidities rather than sarcoidosis itself. In the advanced stage of ocular sarcoidosis, cataracts may be complicated and secondary. Glaucoma, in view of the high incidence of tuberculosis in China, due to long-term use of hormone therapy without anti-tuberculosis drugs, concurrent.

Symptoms of sarcoidosis common symptoms joint swelling parotid gland tachycardia granulomatosis dyspnea hard sweating appetite loss bilateral adrenal hyperplasia subcutaneous nodular keratitis

Sarcoidosis is a systemic granulomatous disease involving the skin and many internal organs. In addition to the skin, the affected parts include the lungs, mediastinum and surrounding lymph nodes, the phalanx, the myocardium, the central nervous system, the liver, the spleen, and the kidney. In the eye and parotid gland, sarcoidosis can only invade one organ or tissue, or multiple organs or tissues can be simultaneously invaded. The condition is slow, and the remission and recurrence alternate. The clinical symptoms of this disease are various.

Skin performance

Sarcoidic skin manifests in a variety of forms, often papules, nodules, plaques, erythroderma, psoriatic-like, scarring sarcoidosis, hypopigmentation and alopecia lesions, lesions are asymmetrically distributed On the face and limbs, the rash is hard and elastic, gradually spreading to the skin, involving the thickness of the entire dermis, the epidermis changes are not obvious, can be slightly thin, discolored, telangiectasia and a little scale, often pale red to purple Brown, not broken, no symptoms.

(1) Papular sarcoidosis: a small nodule with lesions ranging from needle to pea, also known as miliary sarcoidosis, mainly distributed on the face, neck and shoulders. When the slide is pressed, it shows lupus nodules. The pale yellow dots, leaving no trace after disappearing, sometimes leaving pigment spots, atrophy and scars.

(2) Plaque-type sarcoidosis: Hutchinson first reported this unique plaque lesion, a large lobulated nodular plaque with a flat surface and slightly elevated, common in the cheeks, nose and arms.

(3) Psoriasis-like sarcoidosis: plaques with clear boundaries on the trunk and limbs are often present, with psoriasis-like scales on them.

(4) Frostbite-like lupus type: In the parts prone to frostbite, such as ear pregnancy, cheeks, nose, and toes, the symmetry of the infiltrating lighter red or purple-red plaques.

(5) subcutaneous sarcoidosis: also known as Darier-Roussy sarcoidosis, solid subcutaneous nodules from beans to chestnuts, adhesion to the skin, mild epidermis, common to the trunk, rare facial, no symptoms .

(6) Scar mesenoma: The damage occurs in scars, such as burns, folliculitis, and scars on herpes zoster, which enlarge the original scar area and increase the height, resembling keloid.

(7) erythrodermic mesothelioma: diffuse distribution of invasive erythema and scaly patches with unclear boundaries.

(8) Nodular erythematous belloid tumor: some patients with sarcoidosis with multiple joint pain with fever, increased erythrocyte sedimentation rate, X-ray examination of hilar lymphadenopathy, facial, back and extremities stretched to the pain Subcutaneous nodules, red skin on the surface, most common in young women.

(9) mucosal mesothelioma: hard palate in the mouth, cheeks, uvula and tonsil needles, clusters formed into flat plaques, small nodules in the conjunctiva and lacrimal glands.

(10) Other skin lesions: Sarcoidosis may be associated with subcutaneous calcinosis, pruritus, erythema multiforme and folliculitis, skin atrophy, hyperkeratosis, pigmentation increase or decrease may also be caused by the disease.

2. Other organ damage

Sarcoidosis is a systemic disease in which many organs are involved in addition to skin damage.

(1) Lymph node lesions: systemic lymphadenopathy accounts for 50%. The early stage of sarcoidosis is often limited to swelling of the neck or axillary lymph nodes, and then the systemic lymph nodes are enlarged, especially the mediastinum and hilar lymph nodes.

(2) eye damage nodules eye involvement accounted for about 25% to 30%, with iritis, iridocyclitis, the most common is iris granulomatous nodules, lacrimal gland involvement, is a painless nodule Swelling, lacrimal gland lesions are often accompanied by cervical lymphadenopathy, submandibular glands, salivary glands and parotid glands are also involved (Mikulicz syndrome), conjunctivitis, keratitis, retinitis and optic nerve damage, causing blindness.

(3) Lung damage: lung involvement is more common, X-ray examination is punctate, strip or flaky shadow, hilar lymph node enlargement, early clinical symptoms are mild, but silk examination is particularly obvious; late lung fiber Obvious.

(4) Bone and joint: refers to swelling and pain of the phalangeal joints. X-ray examination may have a cavernous cavity. These cyst-like lesions are mostly composed of epithelial-like cell populations, similar to the damage seen by the skin.

(5) Liver: About 20% of patients with liver involvement, mainly manifested as liver nodules, hepatomegaly, elevated serum alkaline phosphatase, biliary cirrhosis, portal hypertension.

(6) Heart: There are often tachycardia, arrhythmia, atrioventricular block, pulmonary hypertension and heart failure.

(7) Kidney: due to blood calcium, increased urinary calcium causes kidney stones or sarcoid glomerulonephritis, leading to renal failure.

(8) The nervous system: Both the central nervous system and peripheral nerves can be damaged.

Sarcoidosis examination

Blood routine: no abnormalities, but occasionally anemia, blood changes in the active period are mostly moderate reduction of peripheral blood lymphocytes, eosinophils can be temporarily increased, occasionally thrombocytopenia and purpura, ESR can be accelerated; 2% ~ 10% with hypercalcemia and hypercalciuria, immunoglobulin concentration generally increased, IgM, IgA and IgG increased, blacks were more than white, C-reactive protein in a few cases can be increased, lesions invaded bones and liver, Alkaline phosphatase can be elevated.

Chest physical examination: usually normal (but X-ray may have extensive abnormalities), except for Lofgren's syndrome, usually no fever, other positive signs are mostly related to granulomas or fibrosis of special organ systems, such as subcutaneous nodules or muscle nodules Slit lamp examination may find eye lesions, palpation may have moderate lymph node enlargement and hepatosplenomegaly, toe deformation indicates skeletal lesions, chronic cases may show lack of nutrition of nails, in addition, there may be acute Signs of arthritis.

1. Ordinary fluoroscopy and CT examination of the chest : Chest radiograph is the main means of finding thoracic sarcoidosis, mainly in the following aspects:

(1) intrathoracic lymphadenopathy: including hilar, mediastinal lymphadenopathy, hilar lymphadenopathy characterized by bilateral symmetry, accounting for 90% to 95%, only one side of the hilar lymph node enlargement only accounted for 1 %3%, the right hilar enlargement is generally more obvious than the left side. Multiple lymph nodes are characteristic. The enlarged lymph nodes of each group can be close in size, or a certain group of lymph nodes can be more prominent and enlarged. The lymph nodes are clear, uniform in density, round or potato-shaped, mediastinal lymph nodes are enlarged in the posterior anterior anterior segment, showing a widening of one or both mediastinal shadows, and about half of the cases have an upper right paratracheal lymphadenopathy. The most frequently violated lymph nodes are the bilateral hilar, right upper mediastinum and aortic window lymph nodes.

(2) Changes in lung parenchyma: there are many forms:

1 interstitial change: the most common, when the lesion is mild, the lung texture is thickened, sometimes there is a rough chaos, sometimes interwoven into a net.

2 alveolar type changes: manifested as unclear pieces, flocculated shadows, distributed in segments.

3 Miliary changes: in the lungs scattered in the miliary shadow, the edge is clear, about 1mm in diameter.

4 intrapulmonary granulomatous lesions: manifested as multiple large nodules in the lungs, no more than interlobular fissures, such changes are extremely rare.

5 fiber scar lesions: double lung hairy glassy shadows, reticular shadows, nodular shadows, and infiltrating shadows with unclear boundaries, is a late manifestation of sarcoidosis, can be complicated by pulmonary bullae, hollow, cystic bronchi Expansion, pneumothorax, and finally developed into pulmonary hypertension and pulmonary heart disease.

(3) pleural lesions: In the past, sarcoidosis was generally considered to be rarely invaded by the pleura, and less than 1% of pleural effusions were present. It is not uncommon to find sarcoidosis with pleural lesions. In recent years, there are statistics of effusions up to 10 %, but generally does not cause a large amount of pleural effusion.

At present, the intracranial sarcoidosis is divided into five stages according to the X-ray findings: Stage 0: normal X-ray examination of the lungs, often manifested as extrapulmonary sarcoidosis, seen in 5% to 10% of cases; Phase I: double Lateral hilar and/or mediastinal lymph nodes are enlarged without pulmonary infiltration, which is found in about 40% of cases; Phase II: bilateral hilar lymphadenopathy with lung lesions, seen in 30% to 50% of patients; III Period: diffuse lung lesions, without lymphadenopathy, seen in 15% of patients; stage IV: extensive pulmonary fibrosis, bullous bullae, pulmonary cysts, poor prognosis, the disease began to be more common in alveolar lesions Lung field lesions, fibrotic lesions are characterized by a progressive period.

2. Biopsy

It is an important means to diagnose sarcoidosis. If the clinical manifestations, chest X-ray examination is consistent with sarcoidosis, histologically proved non-caseous epithelioid cell granuloma formation or Kveim-Siltzbach skin test positive, the diagnosis can be determined, Tissues for biopsy include superficial lymph nodes, mediastinal lymph nodes, enlarged parotid glands, nasal mucosal lesions, subcutaneous nodules, ocular membranes, and lung tissue.

3. Kvein test

It is a specific cellular immune abnormal reaction. The method is as follows: under aseptic operation, the tissue of the sacrificial lymph node is mashed, diluted with physiological saline to a concentration of 1:10, filtered with gauze, and the filtrate is sterilized at 60 ° C. Two hours, after aerobic and anaerobic culture and guinea pig inoculation to determine the sterility, add the same amount of normal saline acid, diluted to 0.25% carbolic acid antigen, 0.1 ~ 0.2ml antigen on the inside of the forearm injection test Within 6 weeks, skin biopsy was performed at the injection site. If there is a typical sarcoidosis, the pathological changes were positive. The positive rate of Kvein test in patients with sarcoidosis was over 90%, and the fake of healthy people and other patients. The positive rate is very low, only 6.5%, so the diagnostic value of this test is very high, and the test can be negative as the disease is relieved.

4. Bronchoalveolar lavage

The number of lymphocytes in normal BALF should not exceed 10%, and can increase to 33% or even 60% in sarcoidosis. It is generally believed that the number of lymphocytes in BALF increases, and >20.5% has a diagnosis of active sarcoidosis. In a certain sense, the sensitivity is 69.1%, but the specificity is poor, 56.3%. The lymphocytes in the BALF are mainly T lymphocytes, and the percentage of T helper lymphocytes (CD4+) is significantly increased, while the T inhibitory lymphocytes The percentage of cells (CD8+) decreased or did not change. The increase of CD4+/CD8+ ratio was the manifestation of active sarcoidosis. The ratio of CD4+/CD8+ in normal BALF was (1.51.8):1, and the activity of sarcoidosis was CD4+/ The ratio of CD8+ is 5-10 times higher than normal, while the ratio of CD4+/CD8+ in peripheral blood (1:2) is highly separated from the ratio of CD4+/CD8+ in BALF.

5. Intradermal test

For the first time, an intradermal test was performed with 1:2000 old knot 0.1ml. If it is negative, then 0.1ml of old 100mg is used as a skin test. If it is still negative, it will help the diagnosis of sarcoidosis.

6. Radionuclide lung scan

When citrate 67Ga is injected into human body, it can be absorbed by normal or abnormal cell tissue. Due to increased blood flow in the inflammatory area, vascular leakage, and 67Ga combined with inflammatory cells and proteins, 67Ga is concentrated in the lesion area, typical The 67Ga radionuclide sign of sarcoidosis is the "panda sign" on the head and face, that is, the lacrimal glands on both sides of the head and face, the nasal mucosa, and the parotid glands on both sides are concentrated with radionuclides, which looks like the facial appearance of the panda. There is also a concentration of radionuclides at the bilateral hilar and mediastinal lymph nodes, consistent with the enlarged lymph nodes, called the "lambda sign" because its appearance looks like an inverted "Y", or the Arabic letter "" Panda sign and lambda sign are rarely seen in other diseases except for sarcoidosis, so they can assist in diagnosis. Although 67Ga is a more sensitive test for pulmonary sarcoidosis, it is due to other granulomatous diseases of the lung. Such as silicosis or pneumonia, lung cancer and other diseases, 67Ga radionuclide scan can also be positive, so it can not be used alone for the diagnosis of sarcoidosis.

7. Serum angiotensin I converting enzyme (sACE) activity

ACE mainly exists on the surface of alveolar macrophages and epithelial cells. It is believed that the increase of sACE activity is related to the granuloma burden of the whole body. According to the results of 875 cases of sarcoidosis in China, the average value of sACE is 37.5±7.6. U/ml, >37.5±2S (standard deviation) is abnormal, 60%~81% sACE increase in active patients, normal level is normal, sACE activity changes with the change of disease condition, sACE activity gradually decreases until recovery Normal, when the disease recurs, the sACE activity is increased again. Therefore, the determination of sACE activity has a certain significance for the judgment of active sarcoidosis and the observation of disease progression, but because of a certain proportion of false positives and false negatives, sACE is measured for nodules. The judgment of the activity of the disease is of limited value.

Diagnosis and diagnosis of sarcoidosis

diagnosis

1. Diagnostic criteria and basis

The diagnosis of sarcoidosis is mainly based on clinical manifestations, pathological evidence and other granulomatous diseases can be diagnosed. In 1993, the Chinese Medical Association Respiratory Diseases Nodular Disease Group conducted the third clinical and pathological diagnosis of sarcoidosis. Revised, the diagnostic criteria are as follows.

(1) Clinical diagnostic criteria:

1 chest radiograph shows bilateral hilar and mediastinal symmetrical lymphadenopathy (occasionally unilateral hilar lymphadenopathy), with or without intrapulmonary reticular, nodular, flaky shadow, if necessary, refer to chest CT Staging.

2 tissue biopsy confirmed or in line with sarcoidosis (Note: the superficial lymph nodes may be enlarged, mediastinal lymph nodes, nodules of the endobronchial membrane, anterior scalene fat pad lymph nodes and liver puncture or lung biopsy, etc.) ).

3Kveim test positive reaction.

4 serum angiotensin-converting enzyme (SACE) activity is elevated (patients with steroid therapy or inactive sarcoidosis can be in the normal range).

55TU PPD-S test or 5TU tuberculin test is negative or weak positive reaction, 6 high blood calcium, high urinary calcium, alkaline phosphatase increased, plasma immunoglobulin increased, T lymphocytes in bronchoalveolar lavage fluid and The results of subgroup examinations can be used as a reference for diagnosing the activity of sarcoidosis. When conditions are available, after SPECT imaging, SPECT imaging or photography is applied to understand the extent and extent of pathological invasion.

Those with 1, 2 or 1, 3 can be diagnosed as sarcoidosis, and 4, 5, and 6 are important reference indicators, pay attention to comprehensive judgment and dynamic observation.

(2) Pathological diagnosis criteria: The pathological changes of sarcoidosis lack specificity, so pathological diagnosis must be combined with clinical, and the following features support the pathological diagnosis of sarcoidosis.

1 The lesion is mainly a granulomatous nodule composed of epithelioid cells. The nodule is small in volume, the size and shape are relatively uniform, and the edge is clear.

There was no caseous necrosis in the nodules, and occasionally there was small focal cellulose-like necrosis in the center of the nodules.

3 nodules often have multinucleated giant cells and a small amount of scattered lymphocytes, surrounded by more lymphocytes infiltrated, and later wrapped in fibrous tissue, nodules can be fused to each other, but usually retain the original nodule contour.

4 The Schaumann body is present in the giant cells, and the probability of birefringence crystallized stellate is more than that of tuberculous nodules, especially more Schumann bodies, or more birefringent nodules under polarized light microscope. When prompted, sarcoidosis.

5 silver staining showed a large number of reticular fiber hyperplasia in the nodules and around the nodules.

6 Special staining showed no pathogenic microorganisms such as tuberculosis (multi-field examination by oil mirror) or fungi, and thin-walled small blood vessels were occasionally seen in 7 nodules.

(3) Diagnostic terms for sarcoidosis:

According to the characteristics of histopathology, combined with clinical data, the following three types of diagnostic terms can be considered.

1 diagnosis of sarcoidosis: pathological findings are typical, clinical features are also typical.

2 no exception to sarcoidosis: granulomatous lesions, atypical pathological features, typical or atypical clinical manifestations.

3 local nodular disease-like reaction: histologically basically consistent with sarcoidosis, but at the same time there are other well-defined diseases, such as malignant tumors.

Sarcoidosis is a granulomatous disease with unclear etiology and pathogenesis. The clinical manifestations vary according to the organ involved. The diagnosis focuses on the exclusion of other diseases, chest X-ray, serum ACE levels and biopsy. The main means of diagnosing sarcoidosis, 67Ga radionuclide scanning is helpful for early detection of lesion range and location.

2. Diagnostic evaluation:

More than 90% of patients with sarcoidosis have chest X-ray changes, so chest X-ray is the main way to find sarcoidosis, but the sensitivity of ordinary plain films is low, the correct rate is only 50%, CT scan and high-resolution CT on bronchioles The diagnosis rate of interstitial fibrosis is higher, which can be more sensitive and accurately reflect the extent of lesions. The combination of the three can improve the accuracy of diagnosis of thoracic sarcoidosis.

The most important means of diagnosis of sarcoidosis is histopathological examination. There are many sites for biopsy. The positive rates are: superficial lymph nodes 65% to 81%; anterior scale muscle fat pads 40% to 75%; transbronchial bronchus The positive rate of microscopic lung biopsy was 62%, such as X-ray with positive rate of plaque nodules of 80%-90%, X-ray no change positive rate of 50%-60%; X-ray I stage 69%, II stage 80%, III 83%, multiple biopsy can increase the positive rate: 8 at 88%, 6 (3 sessions): 89% in stage I, 98% in stage II, 88% in stage III, 100% in 10, chest, lung, Mediastinal biopsy is the most valuable, the positive rate can reach 95% ~ 100%, but chest, lung biopsy trauma, large risk, mediastinal biopsy technology requirements, clinical applications.

3. Diagnosis method

(1) Medical history and physical examination: Sarcoidosis occurs in adults aged 20 to 30 years old. It is more common in women over 40 years old. Due to the lack of characteristic clinical manifestations of the disease, the diagnosis is easily misdiagnosed and missed. Most patients are Correct diagnosis is found after the discovery of lung, eye, lymph node and other lesions, so be alert when there are the following conditions.

1 fever, night sweats, loss of appetite, weight loss, fatigue and other systemic symptoms.

2 repeated rashes and joint pain.

3 difficulty breathing, pressure behind the sternum, cough and so on.

4 superficial lymph nodes, hepatosplenomegaly.

5 eye lesions bilateral uveitis and various retinopathy.

6 other such as parotid gland enlargement, central, peripheral nervous system involvement (facial nerve spasm, diabetes insipidus), heart, kidney, vascular involvement, mental symptoms.

(2) Summary of diagnostic criteria: The diagnosis of sarcoidosis depends on clinical symptoms and signs and tissue biopsy, and excludes other granulomatous diseases. The diagnostic criteria can be summarized as:

1 Chest imaging examination showed bilateral stenosis of the hilar and mediastinal lymph nodes, with or without intrapulmonary mesh, nodular or flaky shadows.

2 histological biopsy confirmed non-caseous necrotizing granuloma and negative for acid-fast staining.

3SACE or SL activity increased.

4 sIL-2R is high in serum or BALF.

5 old tuberculin (OT) or PPD test positive or weak positive.

Lymphocytes >6% in 6BALF, and CD4+/CD8+ ratio 3.

7 high blood calcium, high urinary calcium.

The 8Kveim test was positive.

9 Excluding tuberculosis or other granulomatous diseases, among the above 9 conditions, 1, 2, and 3 are the main conditions, and others are secondary conditions.

(3) The diagnosis of sarcoidosis depends on clinical manifestations and histology to confirm the presence of non-caseal granuloma, and exclude other clinically and histologically similar diseases. Individual organs such as the skin show non-caseal granuloma and Can not diagnose sarcoidosis, the diagnosis of sarcoidosis should establish the following objectives:

1 Histology confirmed.

2 Determine the extent and extent of organ damage.

3 assess the extent of disease activity.

4 Decide if you need treatment.

Differential diagnosis

1. Acute gouty arthritis patients with 5% to 25% can invade the joints, some of which are acute arthritis, 25% of patients can be associated with increased blood uric acid, so it is easy to be misdiagnosed as gout, but this type of arthritis is more Symmetrical, multiple joint involvement, affected parts of the knee, sacral proximal (toe) joints and wrists, elbow joints are the most common, single arthritis is extremely rare, and gout is more than 90% of single joint onset, the most affected part Commonly the first metatarsophalangeal joint, and gout is common in young men, women in the reproductive period are rare, and women with sarcoidosis are more than men. In addition, urate crystals can be found in the joint fluid of gouty arthritis. Identification of the disease.

2. Both rheumatic fever can show multiple joints, migratory inflammation, accompanied by skin nodular erythema, but rheumatic fever is more common in adolescents, and there is often a history of streptococcal pharyngitis before the disease, laboratory tests can find ASO liters High, and SACE is more normal. In addition, rheumatic fever is more likely to have heart inflammation than sarcoidosis, and lung involvement is significantly reduced.

3. Rheumatoid arthritis When the joint damage of sarcoidosis is chronic, and the hand, wrist and other small joints need to be differentiated from rheumatoid arthritis, but the chronic joint changes of sarcoidosis often occur in the late stage of sarcoidosis. Therefore, the performance of lung and other organs and the increase of serum ACE are often coexisting at the same time. In addition, the joint damage of sarcoidosis is mostly non-erosive, while the lesion of RA is mainly in the joint, which is erosive joint destruction and less extra-articular involvement. Light, in addition to RF, can find other antibodies such as anti-Sa, AKA, APF, anti-RA33/36, synovial sarcoidosis is non-case-like granuloma.

4. Bone Paget's disease can be characterized by osteolytic changes, osteosclerosis, or both, similar to Paget's disease, but bone changes in sarcoidosis often involve chronic skin changes and elevated serum ACE levels. The AKP level is normal, and the bone biopsy is not a cheese-like granuloma, which can be distinguished from Paget bone disease.

5. Sjogren's syndrome When sarcoidosis invades the lacrimal gland, the parotid gland can cause dry mouth, dry eyes and gland enlargement, which is easily confused with Sjogren's syndrome, but Sjogren's syndrome should have specific autoantibodies such as anti-SS-A. , anti-SS-B or RF, ANA, etc., pathological examination showed that lymphocytes showed focal infiltration rather than cheese-like granuloma.

6. Multiple myositis Myopathic muscle sarcoidosis is mainly caused by proximal muscle strength reduction and muscle atrophy, CK can be elevated, and EMG can also show myogenic damage, but poor response to glucocorticoid therapy. Muscle biopsy helps identify the two.

7. Vasculitis can involve large, medium and small blood vessels. When invading large blood vessels, it resembles aortic inflammation. Biopsy can be identified.

8. Patients with hilar lymph node tuberculosis often under the age of 20, may have symptoms of tuberculosis, positive tuberculin test, sometimes found tuberculosis in the sputum can be diagnosed, X-ray examination of hilar lymphadenopathy, mostly unilateral, lung The primary lesion was seen in the ministry and the Kveim test was negative.

9. Lung cancer, especially central lung cancer, often accompanied by hilar lymph node metastasis, leading to ipsilateral hilar lymphadenopathy, but primary lung cancer or extrapulmonary tumor metastasis have corresponding symptoms, tomography, lung CT, fibrous bronchi Mirror biopsy, sputum cytology, etc. are helpful for differential diagnosis.

10. Lymphoma is clinically similar to X-ray and immunological changes in sarcoidosis. Common systemic symptoms include fever, weight loss and anemia. The hilar lymphadenopathy often tends to fuse with the right heart ( The hilar lymph nodes of sarcoidosis are often separated from the right heart. There are often symptoms of hilar lymph node compression.

11. Pulmonary mycosis Chest X-ray examination is sometimes similar to sarcoidosis. Finding mold and mold culture can help to differentiate the diagnosis.

12. Other diseases such as left-to-right shunt congenital heart disease, silicosis, viral pneumonia, silicosis, etc. can also cause bilateral hilar lymphadenopathy, while Crohn's disease, primary biliary sclerosis is also a chronic granuloma Sexual lesions, but according to their respective characteristics should not be difficult to identify.

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