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Nodules, Adenopathy, and a Unilateral Opacity Mistaken for Granulomatous Disease

Published:November 18, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.063
      A 48-year-old Cuban woman with prior Bacille Calmette-Guérin vaccination presented with progressive cough, dyspnea, fatigue, and new onset of blood streaked sputum. Years prior, she had a positive tuberculin skin test prompting a chest x-ray, which revealed multiple calcified pulmonary nodules, stable on serial imaging. Seven months prior to admission, she developed cough, constitutional symptoms, and arthralgias. Infectious and rheumatologic evaluations were negative at the time. Chest computerized tomography (CT) revealed bilateral calcified pulmonary nodules, right hilar adenopathy, narrowing of the bronchus intermedius and right lower lobe bronchus, and dominant right lower lobe nodule. She was prescribed glucocorticoids for presumed sarcoidosis and, subsequently, methotrexate for persistent respiratory symptoms.
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