A 45-year-old female presents with persistent dry cough, progressive exertional breathlessness, and tender erythematous subcutaneous nodules over her bilateral shins (erythema nodosum). Chest radiograph reveals bilateral symmetrical hilar lymphadenopathy. Serum angiotensin-converting enzyme (ACE) levels are elevated. What is the most likely diagnosis?
Answer and explanation
Correct answer: D. Sarcoidosis
- Step 1: Sarcoidosis is a multisystem granulomatous disorder characterized by non-caseating granulomas.
- Step 2: The combination of bilateral hilar lymphadenopathy, erythema nodosum, arthritis, and elevated serum ACE in a young adult female represents Lofgren syndrome, a classic acute presentation of sarcoidosis.
Answer
Sarcoidosis.
Why not the others: 'Tuberculosis' presents with caseating granulomas, unilateral asymmetric cavitation, night sweats, and hemoptysis; 'Small Cell Lung Cancer' presents with central masses, rapid metastasis, and paraneoplastic syndromes in elderly smokers; 'Histoplasmosis' typically causes mediastinal calcifications and is linked to bat/bird guano exposure.
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