FN, a 36-year-old female office administrator, presents to the local clinic with complaints of persistent dry cough, shortness of breath, and skin lesions over the past three months.

FN initially developed a dry cough that persisted despite over-the-counter cough medications. She gradually noticed exertional dyspnoea, especially when climbing stairs or walking briskly. Over the last month, she developed painless skin lesions on her arms and legs, which prompted her to seek medical attention. She denies fever, night sweats, weight loss, or joint pain.

FN lives in a densely populated urban area with her husband and two young children. She does not smoke and has no known exposure to occupational hazards. Access to healthcare is relatively good in her urban setting, although specialized care can be limited.

- General: Appears well-nourished, no acute distress

- Vitals: BP 120/80 mmHg, HR 80 bpm, RR 16 breaths/min, SpO2 98% on room air, temperature 37.0°C

- Respiratory: Clear lung fields on auscultation, no wheezes or crackles

- Dermatological: Non-tender erythematous nodules on bilateral arms and legs

- Other Systems: No significant findings

- Chest X-ray: Bilateral hilar lymphadenopathy with diffuse reticular opacities

- High-Resolution CT (HRCT) Scan: Confirms bilateral hilar lymphadenopathy, mediastinal lymphadenopathy, and scattered nodular opacities in the lungs

- Skin Biopsy: Non-caseating granulomas consistent with sarcoidosis

- Blood Tests: Normal complete blood count (CBC), elevated angiotensin-converting enzyme (ACE) levels.

Sarcoidosis

1. Observation and Monitoring: Regular monitoring of symptoms and disease progression.
2. Symptomatic Treatment:

- Corticosteroids (e.g., prednisone) for moderate to severe pulmonary and systemic symptoms.

- Topical treatments for skin lesions as needed.

3. Pulmonary Function Tests: Periodic assessment to monitor lung function.
4. Patient Education: Counselling on the chronic nature of sarcoidosis, potential complications, and the importance of regular follow-up.
5. Referral: Consideration for referral to a pulmonologist or rheumatologist for specialized care and management.

The prognosis for sarcoidosis varies widely, with some patients experiencing spontaneous remission while others may have chronic symptoms requiring ongoing treatment and monitoring.

This case illustrates the typical presentation and challenges of managing pulmonary fibrosis in a patient from an urban area in sub-Saharan Africa, highlighting the impact of occupational exposure on respiratory health.