A 34-year-old electronics industry worker has progressive dyspnea and dry cough. Chest imaging shows bilateral hilar lymphadenopathy and fine reticulonodular infiltrates. Transbronchial biopsy reveals non-caseating granulomas. Which test best separates this condition from sarcoidosis?
- A Serum angiotensin converting enzyme level
- B Beryllium lymphocyte proliferation test ✓
- C High resolution CT showing perilymphatic nodules
- D Bronchoalveolar lavage CD4 to CD8 ratio
Correct answer: B. Beryllium lymphocyte proliferation test
Explanation
Chronic beryllium disease produces non-caseating granulomas that mimic sarcoidosis clinically, radiologically, and histologically. The beryllium lymphocyte proliferation test demonstrates a specific delayed type hypersensitivity response to beryllium salts by sensitized T cells and is the definitive discriminator. ACE levels, HRCT patterns, and BAL CD4:CD8 ratios are abnormal in both diseases and cannot reliably separate them.
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.