Pneumonia USMLE Step 1 Practice Question
A 45-year-old woman with a 3-year history of biopsy-confirmed pulmonary sarcoidosis presents to the emergency department with a 5-day history of fever (38.8°C), progressive dyspnea, and cough productive of scant sputum. Vital signs show tachycardia (102 bpm) and tachypnea (22 breaths/min). She denies recent travel, new medications, or immunosuppressive therapy use. Chest X-ray demonstrates new nodular infiltrates superimposed on her known hilar lymphadenopathy. Flexible bronchoscopy with bronchoalveolar lavage (BAL) shows non-caseating granulomatous inflammation; acid-fast bacilli stain and fungal stains are negative. Fungal and mycobacterial cultures are pending. Which of the following diagnoses must be excluded before attributing her clinical presentation to sarcoidosis exacerbation?
Answer choices
- AAcute sarcoidosis exacerbation with hypercalcemia-induced acute kidney injury
- BOpportunistic fungal infection (histoplasmosis or coccidioidomycosis)Correct answer
- CTuberculosis with concurrent sarcoidosis
- DCommunity-acquired bacterial pneumonia superimposed on sarcoidosis
- ESarcoid-associated pulmonary fibrosis with acute decompensation
- FMedication-induced hypersensitivity pneumonitis
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