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©2013 UpToDate ® Print Email ACCESS study criteria for organ involvement in patients with biopsy-confirmed sarcoidosis-I Organ Definite Probable Lungs 1. Chest roentgenogram with one or more of the following: 1. Lymphocytic alveolitis by bronchoalveolar lavage (BAL) Bilateral hilar adenopathy 2. Any pulmonary infiltrates Diffuse infiltrates 3. Isolated reduced diffusing capacity for carbon monoxide Upper lobe fibrosis 2. Restriction on pulmonary function tests Skin 1. Lupus pernio 1. Macular/papular 2. Annular lesion 2. New nodules 3. Erythema nodosum Eyes 1. Lacrimal gland swelling 1. Blindness 2. Uveitis 3. Optic neuritis Neurologic 1. Positive magnetic resonanceimaging (MRI) with uptake in meninges or brainstem 1. Other abnormalities on magnetic resonance imaging (MRI) 2. Cerebrospinal fluid with increased lymphocytes and/or protein 2. Unexplained neuropathy 3. Diabetes insipidus 3. Positive electromyogram 4. Bell's palsy 5. Cranial nerve dysfunction 6. Peripheral nerve biopsy Hypercalcemia Hypercalciuria Nephrolithiasis 1. Increased serum calcium with no other cause 1. Increased urine calcium 2. Nephrolithiasis analysis showing calcium Cardiac 1. Treatment responsive cardiomyopathy 1. No other cardiac problem and either: 2. Electrocardiogram showing intraventricular conduction defect or nodal block Ventricular arrhythmias Cardiomyopathy 3. Positive gallium scan of heart 2. Positive thallium scan Reproduced with permission from: Judson, MA, RP Baughman, AS. Teirstein, ML Terrin, and H Yeager, Jr. 1999. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases 16:75-86. Copyright © 1999 Sarcoidosis, Vasculitis, and Diffuse Lung Diseases.

©2013 UpToDate ® Print Email ACCESS study criteria for organ involvement in patients with biopsy-confirmed sarcoidosis-I Organ Definite Probable Lungs 1. Chest roentgenogram with one or more of the following: 1. Lymphocytic alveolitis by bronchoalveolar lavage (BAL) Bilateral hilar adenopathy 2. Any pulmonary infiltrates Diffuse infiltrates 3. Isolated reduced diffusing capacity for carbon monoxide Upper lobe fibrosis 2. Restriction on pulmonary function tests Skin 1. Lupus pernio 1. Macular/papular 2. Annular lesion 2. New nodules 3. Erythema nodosum Eyes 1. Lacrimal gland swelling 1. Blindness 2. Uveitis 3. Optic neuritis Neurologic 1. Positive magnetic resonanceimaging (MRI) with uptake in meninges or brainstem 1. Other abnormalities on magnetic resonance imaging (MRI) 2. Cerebrospinal fluid with increased lymphocytes and/or protein 2. Unexplained neuropathy 3. Diabetes insipidus 3. Positive electromyogram 4. Bell's palsy 5. Cranial nerve dysfunction 6. Peripheral nerve biopsy Hypercalcemia Hypercalciuria Nephrolithiasis 1. Increased serum calcium with no other cause 1. Increased urine calcium 2. Nephrolithiasis analysis showing calcium Cardiac 1. Treatment responsive cardiomyopathy 1. No other cardiac problem and either: 2. Electrocardiogram showing intraventricular conduction defect or nodal block Ventricular arrhythmias Cardiomyopathy 3. Positive gallium scan of heart 2. Positive thallium scan Reproduced with permission from: Judson, MA, RP Baughman, AS. Teirstein, ML Terrin, and H Yeager, Jr. 1999. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases 16:75-86. Copyright © 1999 Sarcoidosis, Vasculitis, and Diffuse Lung Diseases. ACCESS study criteria for organ involvement in patients with biopsy-confirmed sarcoidosis - II Organ Definite Probable Nonthoracic lymph node 1. New palpable node above waist 2. Lymph node >2 cm by computed tomographic (CT) scan Parotid/salivary glands 1. Symmetrical parotitis with syndrome of mumps 2. Positive gallium scan ("Panda sign") Renal 1. Treatment responsive renal failure 1. Steroid responsive renal failure in patient with diabetes and/or hypertension Liver 1. Liver function tests > three times normal 1. Compatible computed tomographic (CT) scan 2. Elevated alkaline phosphatase Spleen 1. Enlargement by: Exam Computed tomographic (CT) scan Radioisotope scan Bone marrow 1. Unexplained anemia 2. Leukopenia 3. Thrombocytopenia Bone/joints

1. Steroid responsive renal failure in patient with diabetes and/or hypertension Liver 1. Liver function tests > three times normal 1. Compatible computed tomographic (CT) scan 2. Elevated alkaline phosphatase Spleen 1. Enlargement by: Exam Computed tomographic (CT) scan Radioisotope scan Bone marrow 1. Unexplained anemia 2. Leukopenia 3. Thrombocytopenia Bone/joints 1. Cystic changes on hand or feet phalanges 1. Asymmetric painful clubbing Ears/Nose/Throat 1. Unexplained hoarseness with exam consistent with granulomatous involvement Muscles 1. Increased creatine phosphokinase (CK) aldolase which decreases with treatment 1. Increased creatine, phosphokinase (CK)/aldolase Reproduced with permission from: Judson, MA, RP Baughman, AS. Teirstein, ML Terrin, and H Yeager, Jr. 1999. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases 16:75-86. Copyright © 1999 Sarcoidosis, Vasculitis, and Diffuse Lung Diseases.