USMLE Step 1 Question 391

Question:

A 37-year-old African-American woman presents with fever, anorexia, purple plaques on her shins, dyspnea on exertion, anterior uveitis, and an asymmetric smile. Which of the following MUST be seen for diagnosis of her disease?

Correct Answer: E.  Non-caseating granulomas

This woman has symptoms suggesting sarcoidosis. Of the options, only non-caseating granulomas (choice E) are required for the diagnosis of the disease.

Sarcoidosis is a chronic systemic granulomatous disease often involving multiple organ systems. It occurs most often in female African-Americans. Features include constitutional symptoms, erythema nodosum, dyspnea on exertion, anterior uveitis, and Bell’s palsy, amongst others.

Arthralgias (choice A) are present in 25-30% of cases. Bilateral hilar adenopathy (choice B) is a hallmark of the disease, but is only seen in 50% of cases. Cardiac involvement (choice C) is seen in 5% of cases. Increased serum levels of ACE (choice D) are seen in 50% of cases.