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Microscopic polyangiitis — SCE Rheumatology MCQ

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HardVasculitisMicroscopic polyangiitisSCE Rheumatology

A 31-year-old has acute bilateral ankle periarthritis, erythema nodosum, fever and symmetrical bilateral hilar lymphadenopathy. Calcium is normal and there are no atypical radiological features. What is the best next approach?

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Correct answer: E — Symptomatic Löfgren treatment with clinical-radiological follow-up

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

C is correct. The acute triad of bilateral hilar lymphadenopathy, erythema nodosum and ankle periarthritis is classic Löfgren syndrome, a sarcoid phenotype with a generally favourable course. BTS guidance permits a confident clinical-radiological diagnosis when the presentation is typical, provided follow-up confirms the expected evolution. A adds invasive tissue sampling without an atypical feature. B treats one radiological sign as microbiological proof. D states the correct conservative principle. E uses organ-toxic therapy for a usually self-limiting phenotype. Atypical imaging, exposure risk or failure to improve would reopen the need for tissue and alternative diagnoses.

Reference: British Thoracic Society clinical statement on pulmonary sarcoidosis: https://www.brit-thoracic.org.uk/clinical-resources/clinical-statements/sarcoidosis/