Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 149: A 20-Year-Old with an Abnormal Chest X-Ray
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Jun 5, 2025 A 20-year-old college student faces puzzling symptoms and an abnormal chest X-ray, leading to a deep dive into diagnostic challenges. The discussion shifts to acute sarcoidosis with skin involvement, highlighting unique symptoms like erythema nodosum. Participants dissect the complexities of sarcoidosis, from its mysterious causes to misconceptions about its age demographics. The episode also sheds light on hypercalcemia and the favorable prognosis of Lofgren syndrome, showcasing the wide-ranging impacts of this intriguing condition.
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Lofgren Syndrome Explained
- Lofgren syndrome presents acutely with erythema nodosum, bilateral hilar adenopathy, and fever, usually in young adults.
- It is a form of sarcoidosis with a very good prognosis, often resolving without therapy within two years.
Sarcoidosis Pathophysiology
- Sarcoidosis is a multi-system disease with non-caseating granulomas affecting lungs, skin, eyes, and more.
- The cause is unknown but likely involves an exaggerated immune response to infectious or environmental agents.
Sarcoidosis Across Ages
- Sarcoidosis can present not only in young adults but also in older patients, with a second incidence peak around age 60.
- Median U.S. diagnosis age is about 55, so consider sarcoidosis in older adults too.