29th April 2024

A 45-year-old woman presents with persistent cough, mild breathlessness, and fatigue for the past 3 months.

A 45-year-old woman presents with persistent cough, mild breathlessness, and fatigue for the past 3 months. She also reports experiencing painful, swollen joints, particularly in her wrists and ankles. Additionally, she has noticed red, raised lesions on her legs. She denies any history of smoking or significant past medical history. On examination, her lung sounds are clear, but chest X-ray reveals bilateral hilar lymphadenopathy. A skin biopsy of the leg lesions shows non-caseating granulomas.

Investigations:

Serum calcium: Elevated

Serum angiotensin-converting enzyme (ACE) level: Elevated

Pulmonary function tests: Mild restrictive pattern

Erythrocyte sedimentation rate (ESR): Elevated

Which is the most likely diagnosis?