Löfgren Syndrome — RACP Adult Medicine MCQ

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EasyRespiratoryLöfgren SyndromeRACP Adult Medicine

A 30-year-old woman presents with bilateral hilar lymphadenopathy (BHL) on CXR, erythema nodosum on her shins, and bilateral ankle arthralgia. She is otherwise well. ACE is elevated. Calcium is normal. What is the most likely diagnosis?

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Correct answer: B — Sarcoidosis (Löfgren syndrome)

BHL + erythema nodosum + bilateral ankle arthralgia = Löfgren syndrome (acute sarcoidosis). This triad has >90% spontaneous resolution and excellent prognosis. ACE is elevated in ~60% of sarcoidosis (neither sensitive nor specific). Biopsy showing non-caseating granulomata confirms the diagnosis but may not be needed if the clinical picture is classic. Treatment: NSAIDs for symptoms. Systemic corticosteroids only for progressive disease or organ involvement.

Reference: BTS – 2020 – Sarcoidosis; eTG Respiratory 2024