Differential Diagnosis for a Young Patient with Cough, Fever, Drenching Night Sweats, and Elevated Serum ACE

• Single Most Likely Diagnosis
  • Sarcoidosis: This condition is characterized by the presence of bilateral hilar adenopathy, which is a classic finding, along with symptoms such as cough, fever, and night sweats. Elevated serum angiotensin-converting enzyme (ACE) levels are also commonly seen in sarcoidosis, making it the most likely diagnosis given the combination of clinical and laboratory findings.
• Other Likely Diagnoses
  • Tuberculosis (TB): TB can present with similar symptoms, including cough, fever, night sweats, and can also cause pulmonary infiltrates or fibrosis. While ACE levels are not typically elevated in TB, the clinical presentation can be similar, making TB a consideration.
  • Lymphoma: Certain types of lymphoma, particularly Hodgkin lymphoma, can cause bilateral hilar adenopathy and systemic symptoms like fever and night sweats. However, elevated ACE levels are not a characteristic feature of lymphoma.
• Do Not Miss Diagnoses
  • Malignancy (e.g., Lung Cancer, Lymphangitic Carcinomatosis): Although less likely given the patient's age and the presence of elevated ACE levels, malignancies can cause a wide range of pulmonary and systemic symptoms. It's crucial to consider and rule out cancer due to its significant implications for treatment and prognosis.
  • Infections (e.g., Histoplasmosis, Coccidioidomycosis): Certain fungal infections can mimic the presentation of sarcoidosis, including causing hilar adenopathy and pulmonary infiltrates. These infections are important to consider, especially in endemic areas, as their treatment differs significantly from that of sarcoidosis.
• Rare Diagnoses
  • Berylliosis (Chronic Beryllium Disease): This is a rare occupational lung disease that can cause granulomatous inflammation similar to sarcoidosis, leading to symptoms and findings that overlap with those described. However, it requires a specific occupational exposure history.
  • Other Granulomatous Diseases (e.g., Granulomatosis with Polyangiitis): These conditions can also present with a variety of systemic and pulmonary symptoms but are less common and would typically have additional distinguishing features or organ involvement.