A 30-year-old non-smoker presented with cough and shoness of breath, fatigue, fever and night sweats for 3 weeks. On examination, specific skin lesions were noted over the lower limbs and on ophthalmoscopic examination anterior uveitis was diagnosed. Lab findings revealed elevated alkaline phosphatase levels along with hypercalcemia and raised ACE levels. Lung biopsy was taken. CHEST X -RAY HRCT CHEST What is the diagnosis in the above patient: –

**Core Concept:** Sarcoidosis is a multisystem granulomatous disease of unknown cause, which can affect any organ system, including skin, lungs, liver, and eyes. It is characterized by the presence of non-caseating granulomas in affected tissues, elevated ACE levels (Angiotensin-Converting Enzyme), and hypercalcemia.

**Why the Correct Answer is Right:** In this case, the patient presents with a chronic illness characterized by cough, shortness of breath, fatigue, fever, and night sweats. The skin lesions are a clue to the diagnosis, as they are a common manifestation of cutaneous involvement in sarcoidosis. The ophthalmoscopic examination reveals anterior uveitis, which is a common ocular manifestation of sarcoidosis. Additionally, elevated ACE levels, hypercalcemia, and raised alkaline phosphatase levels are consistent with this diagnosis. A chest biopsy and HRCT (High-Resolution Computed Tomography) of the chest are performed to confirm the pulmonary involvement, which is also a common manifestation of sarcoidosis.

**Why Each Wrong Option is Incorrect:**

A. This option is incorrect because sarcoidosis is a systemic disease, and the patient's symptoms and signs are consistent with the diagnosis.

B. While sarcoidosis can cause lung involvement, this option is incorrect because the patient's symptoms and signs, as well as the confirmed pulmonary involvement on biopsy, are more consistent with sarcoidosis.

C. This option is incorrect because sarcoidosis is a systemic disease and the patient has systemic symptoms and signs, including skin lesions and elevated ACE levels, as well as confirmed pulmonary involvement.

D. While sarcoidosis can cause hypercalcemia, this option is incorrect because the patient's symptoms, signs, and confirmed pulmonary involvement on biopsy are more consistent with the diagnosis of sarcoidosis.

**Clinical Pearl:** Sarcoidosis is a multisystem granulomatous disease of unknown cause. It is often seen in young adults, particularly in those of African, Caucasian, or Asian descent. The diagnosis is typically made based on the clinical presentation, radiological findings, and confirmation of granulomas on biopsy.

✓ Correct Answer: A. Sarcoidosis