Clinical diagnosis of salivary gland sarcoidosis (Heerfordt syndrome)

Sarcoidosis, a systemic granulomatous disease of unknown cause, may involve any body organ. The most common manifestation in the head-neck area is lym phnode sarcoidosis or, alternatively, Heerfordt's syndrome (with involvemen t of lacrimal and parotid gland and possible facial palsy). Far less common is a isolated laryngeal sarcoidosis. The typical histopathological appeara nce proves the diagnosis. However, obtaining representative and sufficent b iopsy material in same cases may carry risks for the patients or might tech nically be difficult. in these cases, the clinician can fall back on two ot her, noninvasive diagnostic procedures:ACE level activity determination in blood serum and (67)gallium citrate scintigraphy. Elevated ACE levels in co mbination with a positive 67gallium scintigraphy have a specificity (combin ed) of 99%. As a valuable side effect, this procedure sensitively may disco ver additional disease in the body and also serves well as a therapy-contro l examination. The presented case report shows clearly that these clinical methods, if combined, a re sufficient far diagnosis of Heerfordt's syndrome /sarcoidosis; no additional histopathological examination is required.