A 29-year-old woman has dry cough, dyspnea, uveitis, and tender shin nodules. Transbronchial biopsy shows noncaseating granulomas containing asteroid bodies. Bronchoalveolar lavage analysis would be expected to show:

• A Eosinophil count exceeding 25 percent of total cells
• B CD4-positive T cell predominance with a raised CD4 to CD8 ratio ✓
• C CD8-positive T cell predominance with a reversed CD4 to CD8 ratio
• D Hemosiderin-laden macrophages exceeding 20 percent

Explanation

Sarcoidosis is driven by exaggerated CD4 helper T cell responses to an unidentified antigen, so BAL fluid characteristically shows lymphocytosis with a CD4 to CD8 ratio greater than 3.5. B reversed ratio favors hypersensitivity pneumonitis, eosinophilia suggests eosinophilic lung disease or drug reaction, and abundant hemosiderin-laden macrophages point to alveolar hemorrhage syndromes such as Goodpasture disease, making each distractor a marker of a different entity.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.