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Sarcoidosis — RACP Adult Medicine MCQ

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ModerateRespiratorySarcoidosisRACP Adult Medicine

A 40-year-old woman presents with dry cough and bilateral hilar lymphadenopathy on chest X-ray. Serum ACE level is elevated. Bronchoscopic transbronchial biopsy shows non-caseating granulomas. Her FVC is 92% predicted and DLCO is 88% predicted. What is the most appropriate management?

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Correct answer: E — Observation with serial pulmonary function tests

This patient has stage II sarcoidosis (bilateral hilar lymphadenopathy with pulmonary infiltrates) with preserved lung function. Most patients with stage I–II sarcoidosis have spontaneous remission. Treatment with corticosteroids is reserved for significant symptoms, declining lung function, or extrapulmonary involvement threatening organ function. Observation with serial PFTs every 3–6 months is appropriate.

Reference: eTG – 2025 – Respiratory; TSANZ – 2020 – Sarcoidosis Position Statement