Review Question - QID 107433

This patient likely has sarcoidosis based on her generalized malaise, signs of uveitis, erythema nodosum, and bilateral hilar adenopathy on chest radiograph.

Sarcoidosis is a systemic inflammatory disease that can affect multiple sites including the lungs, hilar lymph nodes, skin, eyes, liver, heart, kidneys, and brain. Diagnosis is usually based on exclusion of other etiologies, but biopsy of the lesions will typically show noncaseating granulomas. Severity of the disease truly depends on the sites affected, but risk factors for poorer prognosis include involvement of pulmonary, cardiac, and neural tissue, and presence of respiratory symptoms. Protective factors include erythema nodosum, isolated hilar adenopathy on chest radiography, and absence of respiratory symptoms. The treatment typically involves administration of steroids.

Figure/Illustration A shows bilateral hilar adenopathy on chest radiography (arrows). Figure B shows lower extremity erythema nodosum.

Incorrect Answers:
Answer 1: Atypical pneumonia is typically caused by Mycoplasma pneumonia and presents with a "walking pneumonia" picture including a cough, fatigue, fever, malaise, and a chest radiograph demonstrating bilateral interstitial infiltrates.

Answer 2: Pulmonary hypertension can present with shortness of breath, cough, and gradually worsening right ventricular function in a middle aged woman due to the increased vascular resistance of the lungs.

Answer 3: Rheumatoid arthritis presents with bilateral and symmetric joint pain in a middle-aged woman in addition to other systemic signs/findings including malaise, weight loss, fever, fatigue, a normocytic anemia, and joint deformity.

Answer 5: Viral pneumonia would present with a cough and fever and a chest radiograph that may appear normal or have interstitial infiltrates.

Bullet Summary:
Sarcoidosis presents with a fever, cough, malaise, hypercalcemia, and hilar adenopathy on radiography.