Question

A 25 yo African-American female involved in an MVA is found to have bilat. hilar infiltrates on CXR. She is asymptomatic and has no h/o environmental exposures. Remainder of PE is unremarkable; PFT and PPD are negative. Transbronchial biopsy reveals a noncaseating granuloma. Which one of the following would be the most appropriate treatment?

Answer 1

The patient with bilateral hilar infiltrates, a noncaseating granuloma, and no symptoms or functional impairment likely has sarcoidosis and should initially be managed by observation without pharmacological intervention.

Step-by-step explanation:

The case presented describes a 25-year-old African-American female with bilateral hilar infiltrates seen on a chest X-ray (CXR), a noncaseating granuloma found on transbronchial biopsy, a negative pulmonary function test (PFT), and a negative purified protein derivative (PPD) skin test. These clinical findings are highly suggestive of sarcoidosis, a systemic granulomatous disease. Since the patient is asymptomatic and her pulmonary function is normal, the most appropriate treatment in this scenario would often be observation without pharmacological intervention. The course of treatment would change if the patient develops symptoms or if her lung function deteriorates, at which point steroid therapy may be considered.