Sarcoidosis

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Sarcoidosis is an immune-mediated granulomatous inflammatory condition characterized by the formation of non-caseating granulomas, with potential involvement of multiple organ systems.

It can present with psychiatric features such as depression, anxiety, mood disturbance, cognitive dysfunction, behavioural change, hallucinations, and psychosis, particularly in the context of neurosarcoidosis.

Other characteristic features include neurological manifestations of neurosarcoidosis including cranial neuropathies (particularly facial nerve palsy), headache, seizures, cognitive impairment, meningitis, myelopathy, and hypothalamic-pituitary dysfunction. Distinctive features include non-caseating granulomatous inflammation with multisystem involvement, often affecting the lungs, lymph nodes, skin, and eyes.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Respiratory: bilateral hilar lymphadenopathy, pulmonary infiltrates, cough, dyspnoea, and interstitial lung disease are common manifestations.

  • Cardiovascular: cardiac sarcoidosis may cause conduction abnormalities, arrhythmias, cardiomyopathy, and heart failure.

  • Renal/electrolytes: hypercalcaemia and hypercalciuria may occur due to granulomatous macrophage-mediated dysregulation of vitamin D metabolism, with potential complications including nephrolithiasis and renal impairment.

  • Endocrine: hypothalamic-pituitary involvement may cause diabetes insipidus, pituitary hormone abnormalities, and other endocrine disturbances.

  • Hematologic: lymphopenia may occur, reflecting systemic immune dysregulation.

  • Musculoskeletal: arthralgia, inflammatory arthritis, and acute periarthritis (including Löfgren syndrome with ankle periarthritis) may occur.

  • Dermatologic: erythema nodosum, lupus pernio, and other cutaneous granulomatous lesions may occur.

Early diagnosis is important to enable prompt immunomodulatory treatment, identify and manage organ-threatening involvement (particularly neurological, cardiac, ocular, and pulmonary complications), reduce the risk of irreversible functional impairment, and improve prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.