A 29-year-old woman is found to have bilateral hilar lymphadenopathy on a routine chest radiograph. She has tender nodules over both shins and mild ankle pain but is otherwise well, with normal spirometry and no ocular, cardiac or neurological involvement. Transbronchial biopsy shows non-caseating granulomas. What is the most appropriate management?

• A Prednisolone 40 mg daily for 12 months
• B Infliximab infusion
• C Methotrexate 15 mg weekly
• D Observation without specific treatment ✓

Explanation

Stage I sarcoidosis with erythema nodosum and arthralgia represents Loefgren syndrome, which carries an excellent prognosis with spontaneous resolution in the majority within 2 years. Corticosteroids are reserved for patients with significant symptoms, progressive parenchymal disease, or involvement of eyes, heart, nervous system or kidney. Since her lung function is normal and there is no organ-threatening disease, immunosuppression with methotrexate or infliximab is inappropriate and exposes her to needless toxicity.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.