Differential Diagnosis
- Single most likely diagnosis
- Sarcoidosis: The presence of a hilar mass on chest X-ray, weight loss, fatigue, and chronic cough, along with skin manifestations like erythematous rings and a wood-grain pattern, are highly suggestive of sarcoidosis. This condition is known for its multi-system involvement, including the lungs and skin.
- Other Likely diagnoses
- Lymphoma: The combination of weight loss, fatigue, chronic cough, and a hilar mass could indicate lymphoma, which can also have cutaneous manifestations. However, the specific skin pattern described is less typical for lymphoma.
- Tuberculosis: Although less likely given the skin findings, tuberculosis (TB) can cause a hilar mass and systemic symptoms like weight loss and fatigue. The chronic cough also raises the possibility of TB, especially in the context of a hilar mass.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lung Cancer: The presence of a hilar mass and systemic symptoms such as weight loss and fatigue mandates consideration of lung cancer, despite the unusual skin findings. Lung cancer can have paraneoplastic syndromes that might explain the skin manifestations.
- Infectious Diseases (e.g., Histoplasmosis): Certain infectious diseases can mimic the presentation of sarcoidosis, including lung involvement and skin manifestations. These conditions are critical to identify due to their potential for serious morbidity and mortality if not treated appropriately.
- Rare diagnoses
- Erythema Migrans (Lyme Disease): Although the description of rapidly spreading concentric erythematous rings might suggest erythema migrans, the presence of a hilar mass and other systemic symptoms makes this diagnosis less likely. However, in endemic areas, it's a consideration, especially if the patient has been exposed to ticks.
- Necrobiotic Xanthogranuloma: A rare condition that can present with skin lesions and systemic symptoms, including lung involvement. It's associated with paraproteinemias and would be an unusual but possible explanation for the patient's symptoms.