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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 45-Year-Old Man With Severe Dysphagia and Pulmonary Infiltrates*

Yasmine S. Wasfi, MD, PhD; Mitchell L. Margolis, MD
Author and Funding Information

*From the Pulmonary, Allergy, and Critical Care Division, Department of Medicine, University of Pennsylvania, and Philadelphia Veterans’ Affairs Medical Center, Philadelphia, PA.

Correspondence to: Mitchell L. Margolis, MD, Pulmonary Section, Philadelphia Veterans’ Affairs Medical Center, University and Woodland Ave, Philadelphia, PA 19104; e-mail: Mitchell.Margolis@med.va.gov



Chest. 2007;131(4):1256-1259. doi:10.1378/chest.06-0977
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Extract

A 35-year-old African-American man presented with cough and mild dyspnea on exertion over 3 to 4 years. His sister was known to have sarcoidosis. Physical examination revealed a slight man with mild clubbing. The chest radiograph (Fig 1 ) and chest CT scan (Fig 2 ) both demonstrated bilateral diffuse nodular interstitial and alveolar infiltrates, mediastinal and hilar lymphadenopathy, and upper-lobe fibrobullous changes consistent with sarcoidosis. A presumptive diagnosis of sarcoidosis was made; additional evaluation revealed cutaneous anergy, serum angiotensin-converting enzyme level of 108 IU (normal, 8 to 52 IU), chronic uveitis, and marked restriction on pulmonary function testing. No treatment was undertaken at this time.

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