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Sarcoidosis in Sub-Saharan Africa.

Sarcoidosis in Sub-Saharan Africa.

Patient details
- Name: FN - Age: 36 - Gender: Female - Location: Urban area in Senegal - Occupation: Office administrator - Medical History: No significant past medical history
Patient case fields
 Presenting Complaint

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.

 

History of Present Illness

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.

 

Social and Environmental History

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.

 

Physical Examination

- 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

 

 

Diagnostic Workup

- 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.

 

 

Diagnosis

Sarcoidosis

 

Management Plan

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.

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

 

Prognosis

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.

Discussion
No data was found
Questions
1). What prompted FN to seek medical attention initially?

A). Fever and night sweats

B). Persistent dry cough and shortness of breath

C). Joint pain and swelling

D). Abdominal pain

 

2. Which diagnostic test confirmed the presence of sarcoidosis in FN?

A). Echocardiogram

B). Skin biopsy showing non-caseating granulomas

C). Urinalysis

D). Liver function tests

 

3. What finding on the chest X-ray was indicative of sarcoidosis in FN?

A). Pleural effusion

B). Bilateral hilar lymphadenopathy with diffuse reticular opacities

C). Cavitary lesions

D). Cardiomegaly

 

4. What is the initial treatment option recommended for FN's sarcoidosis?

A). Antibiotics

B). Corticosteroids (e.g., prednisone)

C). Antifungal medication

D). Antiviral therapy

Reveal answers

Answers

  1. B). Persistent dry cough and shortness of breath
  2. B). Skin biopsy showing non-caseating granulomas
  3. B). Bilateral hilar lymphadenopathy with diffuse reticular opacities
  4. B). Corticosteroids (e.g., prednisone)