A 34-year-old female presents with dry cough, erythema nodosum, and bilateral hilar lymphadenopathy on chest imaging. Biopsy reveals noncaseating granulomas. What is the diagnosis?
Answer and explanation
Correct answer: B. Pulmonary sarcoidosis
- Step 1: The presentation of bilateral hilar adenopathy with erythema nodosum in a young patient represents Lofgren syndrome, an acute manifestation of sarcoidosis.
- Step 2: The histological demonstration of well-formed, noncaseating epithelioid cell granulomas in the absence of mycobacterial organisms confirms sarcoidosis.
Answer
Pulmonary sarcoidosis.
Why not the others: Tuberculosis histologically produces caseating granulomas with central necrotizing debris and acid-fast bacilli on Ziehl-Neelsen staining. Small cell lung cancer exhibits malignant neuroendocrine sheets with nuclear molding rather than discrete granulomas. Idiopathic pulmonary fibrosis exhibits patchy interstitial fibrosis and honeycombing without granulomatous inflammation.
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