Question:

A patient presents to you with fever, night sweats, ptosis, and bilateral facial nerve palsy. Investigations showed leukocytosis and bilateral hilar lymphadenopathy. Which of the following is the most likely diagnosis?

Updated On: Jun 18, 2025
  • Sarcoidosis
  • Tuberculosis
  • Lymphoma
  • Hypersensitive pneumonitis
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The Correct Option is A

Solution and Explanation

The presented symptoms and investigation findings strongly suggest sarcoidosis as the most likely diagnosis. Here's a detailed breakdown:
1. Ptosis and bilateral facial nerve palsy: The neurological manifestations, such as facial nerve involvement, are consistent with neurosarcoidosis, although rare, it's a known complication of sarcoidosis.
2. Fever and night sweats: These are common systemic symptoms of sarcoidosis due to its inflammatory nature.
3. Leukocytosis: An elevated white blood cell count can occur in sarcoidosis as part of the body's response to inflammation.
4. Bilateral hilar lymphadenopathy: This is a hallmark radiographic finding of sarcoidosis, seen in chest X-rays or CT scans.
Given the clinical and radiographic findings, sarcoidosis is the most fitting diagnosis among the provided options.
Other options are less likely due to the following reasons:
1. Tuberculosis: While it presents with fever, night sweats, and lymphadenopathy, bilateral facial nerve palsy and ptosis are not typical.
2. Lymphoma: Can present with similar systemic symptoms and lymphadenopathy, but facial nerve involvement is less typical.
3. Hypersensitive pneumonitis: More commonly causes respiratory symptoms rather than the neurological and systemic symptoms noted.
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