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Sarcoidosis Well-Controlled HIV — SCE Infectious Diseases MCQ

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HardImmunocompromised HostSarcoidosis Well-Controlled HIVSCE Infectious Diseases

A person with well-controlled HIV develops asymptomatic bilateral hilar lymphadenopathy. Biopsy shows non-caseating granulomas, and mycobacterial and fungal investigations are negative. What is the most likely diagnosis?

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Correct answer: B — Sarcoidosis after exclusion of infectious and malignant granulomatous disease

The best answer is “Sarcoidosis after exclusion of infectious and malignant granulomatous disease”. Sarcoidosis can occur de novo or with immune recovery in HIV; granulomas are not specific, so the diagnosis requires exclusion of TB, fungi, foreign material and malignancy. BHIVA guidance governs investigation and treatment of HIV-associated disease and supports standard specialist care when HIV is virologically controlled. Non-caseating granulomas support sarcoidosis only after infection and other granulomatous causes are excluded; treatment depends on organ risk and symptoms.

Reference: BHIVA clinical guidelines: https://bhiva.org/clinical-guidelines/ BTS clinical statement on pulmonary sarcoidosis: https://thorax.bmj.com/content/76/1/4