## Diagnosis: Sarcoidosis with Granulomatous Inflammation The clinical triad of **bilateral hilar lymphadenopathy + erythema nodosum + non-caseating granulomas** is pathognomonic for **sarcoidosis** (Löfgren syndrome). The absence of acid-fast bacilli excludes tuberculosis. ## First-Line Treatment: Corticosteroids **Key Point:** Corticosteroids are the **gold standard and first-line treatment** for symptomatic sarcoidosis. Prednisolone is the preferred agent. ### Indications for Corticosteroid Therapy - Symptomatic pulmonary involvement (dyspnea, cough) - Hypercalcemia or hypercalciuria - Cardiac or neurological involvement - Progressive radiological changes - Erythema nodosum (if symptomatic) ### Typical Dosing Regimen | Phase | Dose | Duration | |-------|------|----------| | Initial | Prednisolone 0.5–1 mg/kg/day (usually 20–40 mg/day) | 4–6 weeks | | Maintenance | Taper gradually | 6–12 months total | **High-Yield:** Corticosteroids suppress granuloma formation by inhibiting T-cell activation and macrophage function. They are effective in reducing inflammatory burden and symptoms. **Clinical Pearl:** Löfgren syndrome (the acute form with hilar lymphadenopathy + erythema nodosum + arthralgia) has a good prognosis and often resolves spontaneously, but corticosteroids accelerate symptom resolution and prevent progression to pulmonary fibrosis. **Mnemonic:** **SARCOID** — Systemic, Autoimmune, Responsive to steroids, Caseating-negative, Organ-multisystem, Inflammatory, Diagnosis by biopsy.
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