32Y/F presents to medicine opd with stridor and dry cough from last few weeks. she complains of difficulty in breathing on exeion and in resting condition as well . O/E she had Erythema Nodosum on lower limbs along with painful ahritis.B/L hilar lymphadenopathy Lab investigations had shown raised levels of Angiotensin conveing enzymes (ACE). Her chest radiograph is shown below.The probable diagnosis in this case is?
Correct Answer: Sarcoidosis
Description: History of dry cough , stridor , dyspnea and raised levels of ACE along with chest x-ray finding depicting bilateral hilar adenopathy, this patient is most likely suffering from sarcoidosis. Sarcoidosis Lung involvement occurs in almost 90% of cases In CT scan, features of peribronchial thickening and reticular nodular changes are seen, These changes are predominantly subpleural. CT scan is more sensitive,But CXR remains the preferred method of characterizing the chest involvement B/L hilar adenopathy Erythema Nodosum =Pneumonia is less likely as CXR don't show any pulmonary infiltrates =ACE levels are normal in pulmonary TB and histoplasmosis, although both have B/L lymphadenopathy of pulmonary hilar nodes
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