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Heerfordt Syndrome — SCE Neurology MCQ

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HardCNS InfectionsHeerfordt SyndromeSCE Neurology

A 34-year-old has bilateral granulomatous anterior uveitis, sequential facial-nerve palsies and painless parotid enlargement. Chest CT shows bilateral hilar lymphadenopathy, including a station 7 node accessible to endobronchial ultrasound. Before prolonged immunosuppression, which diagnostic approach is most appropriate?

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Correct answer: E — Obtain EBUS-guided mediastinal-node tissue for granulomas and mimics

The phenotype is highly suggestive of sarcoidosis with neurological involvement. Because an accessible mediastinal node is available, EBUS-guided tissue can establish granulomatous disease and test for mimics without risking a facial nerve or normal brain. Histology showing non-caseating granulomas supports sarcoidosis once infection and other granulomatous disorders are excluded. Serum ACE lacks sufficient diagnostic specificity. Hilar adenopathy and uveitis help direct this lower-risk biopsy strategy and avoid unnecessary neurological tissue injury.

Reference: Neurosarcoidosis: a clinical approach to diagnosis and management: https://pmc.ncbi.nlm.nih.gov/articles/PMC5413520/