A 29-year-old woman presents with fever, tender nodules on both shins, and ankle joint pain. Chest radiograph reveals symmetric bilateral hilar lymphadenopathy with clear lung fields. She has no breathlessness and pulmonary function is normal. Which statement about her condition and prognosis is correct?
- A She has Löfgren syndrome with a high rate of spontaneous resolution ✓
- B She requires immediate high-dose corticosteroids to prevent fibrosis
- C The hilar nodes indicate stage III sarcoidosis with poor outlook
- D Erythema nodosum here signals cutaneous sarcoidosis requiring methotrexate
Explanation
The combination of erythema nodosum, bilateral hilar lymphadenopathy, ankle periarthritis and fever is Löfgren syndrome, an acute presentation of sarcoidosis that resolves spontaneously in the great majority of patients, often within weeks, needing only symptomatic NSAIDs. Bilateral hilar nodes with clear lung fields correspond to stage I disease, not stage III. Corticosteroids are reserved for symptomatic organ-threatening disease, and the shin nodules represent a reactive panniculitis associated with sarcoidosis, not specific cutaneous sarcoid lesions such as lupus pernio.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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