29th April 2024

A 34-year-old man presents with a 4-month history of dry cough, fatigue, and mild shortness of breath.

A 34-year-old man presents with a 4-month history of dry cough, fatigue, and mild shortness of breath. He also reports experiencing painful, swollen joints, particularly in his ankles and knees. Recently, he noticed small, tender, red bumps on his shins. He has no significant past medical history and is a non-smoker. On examination, bilateral hilar lymphadenopathy is observed on a chest X-ray. His pulmonary function tests show a restrictive pattern.

Investigations:

Serum angiotensin-converting enzyme (ACE) level: Elevated

Calcium: Elevated

Chest X-ray: Bilateral hilar lymphadenopathy

Skin biopsy of the lesions on his shins: Non-caseating granulomas

Which is the most likely diagnosis?