Site icon New

MCQ – 98876

amit18289

Question

A 26 year old woman presents with fever, arthralgia and erythema nodosum. Her chest X-ray reveals bilateral hilar lymphadenopathy. Her mantoux test is negative. The most likely diagnosis is:
A. Tuberculosis
B.

Allergic bronchopulmonary aspergillosis
C.

Sarcoidosis
D.

Pulmonary thromboembolism
Show Answer

Correct Answer � C

Explanation

Sarcoidosis is a systemic granulomatous disorder of unknown etiology, characterized by non-caseating granulomas that predominantly affect the lungs and intrathoracic lymph nodes.

Classic Triad of Löfgren’s Syndrome (Acute Sarcoidosis):

  1. Fever
  2. Erythema nodosum (painful red nodules on the shins)
  3. Bilateral hilar lymphadenopathy (BHL)

Arthralgia/polyarthritis (often ankles) is also common in young females.

Key Diagnostic Clues in This Case:

  1. Bilateral hilar lymphadenopathy (BHL) on CXR:

    • Strongly associated with sarcoidosis, especially when accompanied by systemic symptoms like fever and arthralgia.

  2. Erythema nodosum (EN):

    • A classic cutaneous manifestation of sarcoidosis, especially in young women.
    • Represents a good prognostic indicator in sarcoidosis.

  3. Negative Mantoux test (Tuberculin skin test):

    • In sarcoidosis, there is anergy due to T-cell dysfunction, resulting in a negative Mantoux test despite granulomatous inflammation.

Other Supporting Findings in Sarcoidosis:

  • Hypercalcemia/hypercalciuria (due to increased 1α-hydroxylase activity in granulomas).
  • Elevated serum angiotensin-converting enzyme (ACE).
  • Restrictive lung pattern with reduced DLCO on PFTs.

Why Not the Other Options:

  • A. Tuberculosis:

    • BHL may occur in primary TB but is usually unilateral or associated with parenchymal infiltrates.
    • Positive Mantoux test is expected unless immunocompromised.
    • Erythema nodosum can occur in TB but is less common than in sarcoidosis.

  • B. Allergic Bronchopulmonary Aspergillosis (ABPA):

    • Typically presents with asthma, eosinophilia, and central bronchiectasis on imaging.
    • No BHL or erythema nodosum.

  • D. Pulmonary Thromboembolism (PTE):

    • Presents with acute dyspnea, chest pain, and hypoxia, not BHL or erythema nodosum.
    • CXR may show Westermark’s sign or Hampton’s hump, not BHL.
Exit mobile version