Which of the following is the most likely diagnosis?
A 50-year-old woman has lived in Oslo, Norway all her life and worked as a seamstress. She is a non-smoker, but she has had increasing shortness of breath, fever, weight loss, and night sweats for the past 4 months. On physical examination her temperature is 37.6 C. There are fine rales auscultated in all lung fields. A chest radiograph reveals hilar lymphadenopathy and a reticulonodular pattern of small densities in all lung fields. She demonstrates anergy by skin testing to mumps and Candida antigens. A transbronchial biopsy is performed that microscopically shows numerous small pulmonary interstitial non-caseating granulomas.
A. Histoplasmosis B. Adenocarcinoma C. Sarcoidosis D. Usual interstitial pneumonitis E. Berylliosis F. Tuberculosis G. Extrinsic allergic alveolitis
Sarcoidosis -(c) correct. sarcoidosis is typified by non-caseating granulomas. however, culture of the tissue and a careful search histologically should be made for organisms.(a) incorrect. histoplasmosis is most common in the mississippi and ohio river valleys in the us. the dimorphic fungi tend to mimic tuberculosis and can have granulomas with central caseation.(b) incorrect. adenocarcinoma should yield malignant cells, not granulomas, on biopsy.(d) incorrect. uip is the end result of a diffuse fibrosing alveolitis. many cases are idiopathic. the end stage is a honeycomb lung. no granulomas are seen.(e) incorrect. though berylliosis can produce sarcoid-like granulomas, it is very uncommon. an environmental history would be helpful.