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Sarcoidosis — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)SarcoidosisUSMLE Step 3

A 36-year-old Black woman has cough, fatigue, and ankle pain. Chest radiograph shows bilateral hilar lymphadenopathy. Serum calcium is mildly elevated. Transbronchial biopsy shows noncaseating granulomas; acid-fast and fungal stains are negative. Which of the following is the most likely diagnosis?

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Correct answer: E — Sarcoidosis

Noncaseating granulomas with bilateral hilar lymphadenopathy and hypercalcemia are typical of sarcoidosis after infection is excluded.

Reference: American Thoracic Society sarcoidosis guideline: https://www.thoracic.org/