Question

A 44-year-old woman presented to the primary care clinic with a 2-year history of shortness of breath with minimal exertion, cough productive of clear sputum, generalized fatigue, and an unintentional weight loss of 9 kg. She reported no chest pain at rest or with exertion. She had been feeling fatigued most days and had decreased appetite.

Seven months before the current presentation, a rash that was characterized by small, painless, nonpruritic red-brown papules developed on her arms and hands and resolved spontaneously.

What is the most Likely Diagnosis?

A. Chronic obstructive pulmonary disease (COPD)
B. Sarcoidosis
C. Tuberculosis
D. Systemic lupus erythematosus (SLE)
E. Hypersensitivity pneumonitis

Correct Answer: B. Sarcoidosis

Trigger (Unknown Antigen or Immune Dysregulation)
⬇️
🧠 Activation of Immune System

Antigen-presenting cells (e.g., macrophages) activate CD4+ T cells
⬇️
Formation of Non-Caseating Granulomas

Aggregates of macrophages, epithelioid cells, and multinucleated giant cells
⬇️
🧠 Granuloma-Associated Inflammation in Affected Organs

Lungs

Inflammatory granulomas in interstitial spaces
⬇️
Reduced Lung Compliance

Restrictive lung disease
⬇️
Pulmonary Symptoms

Shortness of breath with minimal exertion

Cough productive of clear sputum

Systemic Effects

Cytokines (e.g., TNF-alpha) and chronic inflammation
⬇️
Constitutional Symptoms

Fatigue, weight loss, decreased appetite

Skin Involvement

Granulomas form in the dermis
⬇️
Nonpruritic, Red-Brown Papules

Resolve spontaneously as inflammation subsides

⬇️
🧠 Ongoing Granulomatous Inflammation

Organ damage if untreated (e.g., pulmonary fibrosis, systemic complications)

Explanation of Other Answers

COPD: Requires smoking history, wheezing, and hyperinflation

Tuberculosis: Fever, night sweats, hemoptysis absent; granulomas here lack central necrosis

SLE: No autoantibody markers or systemic lupus criteria (malar rash, arthritis, renal, etc.)

Hypersensitivity Pneumonitis: Needs antigen exposure; no acute inflammatory symptoms

Flashcards

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