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Old 08-11-2011
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Lungs African-American with non-caseating granuloma

A 43 year old African American man presents to you complaining of malaise, 10 pound weight loss, nocturnal fevers and cough from several weeks. He has no significant medical history and has not had any travel but he is a former prisoner. His CXR shows some hilar prominence. A palpable node in the supraclavicular bed is biopsied & pathology reveals well-formed, non-caseating granulomas. What is the most likely diagnosis?

A) M. Tuberculosis
B) Adenocarcinoma of the lung, metastatic
C) Squamous cell carcinoma of the lung, metastatic
D) Sarcoidosis
E) M. Avium complex (MAC)
F) Hodgkin's lymphoma
G) HIV Infection
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Old 08-11-2011
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Sarcoidosis
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Old 08-11-2011
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Originally Posted by val7 View Post
Sarcoidosis

I would agree, but severe weight loss and fever? what justifies that?
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Old 08-11-2011
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d) sarcoidosis - well formed-non caseating granuloma is sarcoid granuloma
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Old 08-12-2011
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lol i guess he did bad things in the prison and he got HIV and this could be lymphoma or histocytosis im not sure but i think they wanted us to think about what they do in the prison if they stay for long time
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lol i guess he did bad things in the prison and he got HIV and this could be lymphoma or histocytosis im not sure but i think they wanted us to think about what they do in the prison if they stay for long time

but the problem is HIV ppl can't form granulomas.. so that is out .. right?
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sarcoidosis
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I agree D) Sarcoidosis

The correct answer is D) Sarcoidosis.

Key words included here that raise concern for Sarcoidosis are -
  • African-American
  • Constitutinoal symptoms
  • Bilateral hilar adenopathy
  • Pulmonary Complaints
  • Non-caseating Granulomas (diagnostic)

The fact that the question stem says he was in the "Prison" is a distractor and points to differential of TB or HIV as some said. However, the biopsy of a patient with TB would show caseating granulomas and acid fast bacilli would probably be seen!
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