Importantly

• What is the reason for suspicion of this diagnosis?
  • Checklist for medical examination here
• Where should the referral be sent (please see below)?

What type of specialist depends on the organ manifestations

• Mainly joint affection: Rheumatologist
• Pulmonary abnormalities mainly: Lung specialist
• Liver manifestation must be clarified: Gastroenterologist
• Cardiac disorders: Cardiologist
• Eye: Ophthalmologist
• Skin: Dermatologist

Disease history

• What typical organ symptoms?
• General condition is affected (night sweat / some fever, fatigue, weight loss)?

Medical examinations

• Enlarged lymph nodes by palpation
• Hepatosplenomegaly
• Heart failure and / or rhythm disturbance
• Auscultation of lungs
  • Crepitations
• X-ray examination or CT examination of lungs (Enlarged hilus glands or Interstitial pulmonary disease)
• Lung function tests
  • Preferably with DLCO / TLCO (gas diffusion)
• Auscultation of heart
• ECG (rhythm disturbances)

• Blood tests

  • Blood sedimentation rate (ESR) and CRP (moderate increase)
  • Leukocytes (Leukopenia among 5 - 10%)
  • ACE (angiotensin converting enzyme increased by generalized disease)
  • IgG (low among 80%)
  • Calcium (increased)
  • Alkaline phosphatase and liver enzymes (increased)

• Biopsies: Granulomas

Differential diagnosis

• Infection
• Malignancy
• Vasculitis diseases
• Connective Tissue Disease

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