A 41-year-old man presented to the emergency department with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive, discrete, rubbery cervical, supraclavicular and axillary lymphadenopathy. Plain radiography of the chest showed bilateral hilar lymphadenopathy. The serum calcium level was elevated at 16.2 mg per deciliter; serum parathyroid hormone is within normal range.
The treatment regimen consists of
A 41-year-old man presented to the emergency department with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive, discrete, rubbery cervical, supraclavicular and axillary lymphadenopathy. Plain radiography of the chest showed bilateral hilar lymphadenopathy. The serum calcium level was elevated at 16.2 mg per deciliter; serum parathyroid hormone is within normal range.
The treatment regimen consists of
💡 Explanation
## Core Concept
The patient's presentation suggests **Sarcoidosis**, a systemic granulomatous disease characterized by the formation of non-caseating granulomas in various organs, most commonly the lungs and lymph nodes. The clinical features, such as bilateral hilar lymphadenopathy, cough, exertional dyspnea, nocturnal diaphoresis, weight loss, and lymphadenopathy, along with hypercalcemia, are indicative of this condition. Hypercalcemia in sarcoidosis is due to the overproduction of **1,25-dihydroxyvitamin D** by activated macrophages within the granulomas.
## Why the Correct Answer is Right
The correct treatment for sarcoidosis, especially with systemic involvement and symptoms as described, often includes **corticosteroids** as the first line of treatment. Corticosteroids effectively reduce inflammation, suppress the immune system, and consequently decrease the formation of granulomas. This leads to an improvement in symptoms and a reduction in the size of lymphadenopathy. The use of corticosteroids also helps in managing hypercalcemia by reducing the production of **1,25-dihydroxyvitamin D**.
## Why Each Wrong Option is Incorrect
- **Option A:** This option is not provided, but typically, treatments that are not anti-inflammatory or immunosuppressive would not be the first line for sarcoidosis.
- **Option B:** Similarly, without specifics, any option not involving corticosteroids or other immunosuppressive/anti-inflammatory agents would be less appropriate for initial management.
- **Option C:** This option is also not specified, but treatments not aimed at reducing granuloma formation or inflammation would not be ideal.
## Clinical Pearl / High-Yield Fact
A key point to remember is that **hypercalcemia of sarcoidosis** is due to the abnormal production of **1,25-dihydroxyvitamin D**, not primary hyperparathyroidism, which is why the serum parathyroid hormone level is normal. Corticosteroids are a cornerstone in the management of symptomatic sarcoidosis.
## Correct Answer Line
**Correct Answer: D. Corticosteroids.**
✓ Correct Answer: A. Chemotherapeutic regimen of doxorubicin, bleomycin, vinblatine, and dacarbazine
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