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 lymphnode sarcoidosis or, alternatively, Heerfordt's syndrome (with involvement of lacrimal and parotid gland and possible facial palsy). Far less common is a isolated laryngeal sarcoidosis. The typical histopathological appearance proves the diagnosis. However, obtaining representative and sufficent biopsy material in same cases may carry risks for the patients or might technically be difficult. in these cases, the clinician can fall back on two other, noninvasive diagnostic procedures:ACE level activity determination in blood serum and (67)gallium citrate scintigraphy. Elevated ACE levels in combination with a positive 67gallium scintigraphy have a specificity (combined) of 99%. As a valuable side effect, this procedure sensitively may discover additional disease in the body and also serves well as a therapy-control 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.