A 25 years old patient came to the clinic
complaining of cough on and off for 1
year. The cough is nonproductive, and is
has worsened in the last 4 months. She
feels tired, has occasional low grade
fever, mild dyspnea on exertion, and has
lost 5 pounds. The patient has no history
of asthma or tobacco use. She has
experienced intermittent pain in her
shoulder and knees. She has also noticed
that her vision has worsened in the last
two weeks.
She is well nourished and is in no acute
distress. There are mobile enlarged
anterior cervical and epitrochlear lymph
nodes. Pulmonary examination reveals
bilateral dry crackles. She has pain with
motion. Painful red nodules are seen on
her anterior aspect of the legs.
Initial diagnostic plan:
1) chest x-ray: symmetrical bilateral
hilar lymph nodes; normal lung
parenchyma.
2) complete blood count: normal.
3) purified protein derivative skin test:
less than 5mm.
4) acid-fast bacillus and septum culture:
negative
5) antinuclear antibodies: negative
based on the history and physical
examination, along with the initial
diagnostic plan, what are the 3 possible
disease states in your differential
diagnosis.
What is the most likely diagnosis of this
patient? Argue your point.
