A chest radiograph of a 26-year-old woman shows symmetric bilateral hilar lymphadenopathy with clear lung fields. She also has tender ankle swelling and erythematous raised shin lesions. Which statement about her condition is correct?

• A She has stage II sarcoidosis with a poor prognosis
• B This presentation carries a high likelihood of spontaneous resolution ✓
• C Serum angiotensin-converting enzyme level confirms the diagnosis
• D Caseating granulomas on biopsy would be expected

Explanation

This is Loefgren syndrome, the combination of erythema nodosum, bilateral hilar lymphadenopathy, and often ankle arthritis, which represents an acute presentation of sarcoidosis with an excellent prognosis and frequent spontaneous resolution. Radiographically it is stage I disease (lymphadenopathy without parenchymal involvement); stage II adds infiltrates. Serum ACE is supportive but neither sensitive nor specific enough to confirm diagnosis, and sarcoid granulomas are characteristically non-caseating.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.