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Progressive pulmonary sarcoidosis — SCE Respiratory MCQ

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HardInterstitial Lung DiseaseProgressive pulmonary sarcoidosisSCE Respiratory

A 39-year-old woman has progressive dyspnoea, dry cough and fatigue. CT shows bilateral hilar lymphadenopathy, perilymphatic nodules and upper-zone fibrosis. Serum calcium is 2.85 mmol/L and FVC has fallen by 12% over 9 months. What is the most appropriate management?

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Correct answer: A — Start systemic corticosteroid treatment after excluding infection

Progressive pulmonary sarcoidosis with functional decline and hypercalcaemia warrants systemic treatment after excluding infection and alternative diagnoses. Observation is reasonable for mild stable disease but not progressive fibrotic or metabolically active disease. Antifibrotics and macrolides are not first-line treatment for this sarcoidosis phenotype.

Reference: BTS Clinical Statement on Pulmonary Sarcoidosis