Case history
Case history #1
A 25-year-old otherwise healthy woman awakens with a mild sore throat, fatigue, pain in both ankles, and red lesions on her legs. She reports weakness and fatigue for the past 2 days, but denies fever, chills, nausea, or night sweats. There is no history of using recreational drugs, oral contraceptives, or other medications. She lives in Chicago and has not traveled abroad for 3 years. Physical examination reveals red, tender, fixed, deep-seated nodules on both shins. Her ankles are mildly swollen and tender and she reports difficulty bearing weight. Chest, cardiovascular, and ophthalmologic examinations are normal. A chest x-ray shows left lower lobe infiltration. Her tuberculin skin test is negative. She is diagnosed with pneumococcal pneumonia.
Case history #2
A 28-year-old medical student from Barbados, who has lived in New York for the last 10 years, awakens with red eyes, photophobia, and nodules on her legs. She denies fever, malaise, cough, or joint pains. She enjoys dairy products but denies recent consumption of raw milk or cheese. She does not take recreational drugs. Physical examination shows bilateral iritis and enlarged lachrymal glands. Chest and cardiovascular examinations are normal, though the skin exam reveals many dark red nodules on her legs and lower thighs. These skin nodules are tender and nonmobile. Her tuberculin test is negative, but a chest x-ray shows bilateral hilar adenopathy consistent with the diagnosis of sarcoidosis.
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