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Clinical Case 3
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Objectives:

  • Recognize the clinical manifestations of sarcoid
  • Approach and treat a patient with sarcoidosis



1

A 35-year-old African American female presents with dyspnea, worsening over the last 2 months. She also complains of cough, generalized fatigue, and intermittent low-grade fevers. She does not smoke. Chest x-ray shows hilar adenopathy and small bilateral pleural effusions. Spirometry is consistent with a restrictive pattern.

Of the following, which is the most likely diagnosis?

A)Wegener’s granulomatosis.
B)Sarcoidosis.
C)Bronchogenic carcinoma.
D)Pneumonia.
2

Which of the following is NOT commonly associated with sarcoidosis?
A)Hypercalcemia.
B)Elevated angiotensin-converting enzyme levels.
C)Reduced diffusion capacity.
D)Hypothyroidism.
E)Peripheral nerve facial palsy.
3

Which of the following is NOT found as a part of sarcoidosis?
A)Erythema nodosum.
B)Myocardial infarction.
C)Cardiac arrhythmias.
D)CNS findings such as headache, visual changes, etc.
E)Ocular involvement, including visual loss.
4

Which of the following is true about angiotensin-converting enzyme (ACE) levels in sarcoidosis?
A)An elevated ACE level is specific for sarcoidosis.
B)ACE levels can be used to track the disease severity in sarcoidosis.
C)ACE inhibitors are effective in the treatment of sarcoid.
D)All of the above.
E)None of the above
5

This patient is found to have only pulmonary sarcoidosis with some mild systemic symptoms.

Which of the following is the best initial choice for management?

A)Observation.
B)Oral corticosteroids.
C)Oral antibiotics.
D)Inhaled corticosteroids.
E)Methotrexate.





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