What is your approach to management of a patient with sarcoidosis who is asymptomatic, but demonstrates progressively enlarging mediastinal lymphadenopathy and rising soluble IL-2 receptor levels?

My concern here would be whether such a patient does not have 'asymptomatic sarcoidosis' but has CVID (often associated with multifocal non-caseating granulomas) with an associated B-cell lymphoma (for which such patients have a 30-fold Relative Risk) with developing mHLH (elevated sIL-2 being an as...

Let's assume that other causes of T-cell activation have been excluded, such as lymphoma, infection, and autoimmune disease, and we are confident in our diagnosis of sarcoidosis. We do not know the cause of sarcoidosis, and it is possible that the granulomatous response is "a good thing." Many indiv...