Feedback:
Discharge her from clinic
Review again on at least one further occasion in 6 months
- While she will probably do very well, with spontaneous resolution of her disease, it is reasonable to see her in several months time and perhaps consider discharge if she is systemically well with no change in her chest radiograph or lung function
- Sarcoidosis can progress and remember that granulomatous inflammation, in itself, is non-specific and a diagnosis of sarcoidosis is essentially a diagnosis of exclusion
- Tuberculosis and lymphoma are the top 2 diseases in your differential
Start oral corticosteroid
- She is asymptomatic with no serious organ involvement or impairment of lung function
Start inhaled corticosteroid
- There is no strong evidence that this is of benefit
- Occasionally inhaled corticosteroids are used for topical airway effect in a patient with endobronchial sarcoidosis e.g. with cough
Follow her up for life with 6 monthly clinic review
- 90% of patients who present with erythema nodosum and stage I disease will have spontaneous resolution of their sarcoidosis
Do a mediastinoscopy
- This is not necessary unless there was diagnostic doubt e.g suspected lymphoma
- Furthermore the use of EBUS has largely replaced mediastinoscopy in many patients