Medical Challenge - Answer
The answer to the NEJM challenge is #2. Angiotensin Converting Enzyme.
Lupus pernio is a skin manifestation of sarcoidosis that involves the nasal bridge and cheeks. Serum levels of the angiotensin-converting enzyme are elevated in the majority of patients with untreated sarcoidosis.
Sarcoidosis is an autoimmune disease that causes inflammatory cells to clump in various parts of the body, commonly the lungs, lymph nodes, eyes and skin. It can develop slowly over years or it can appear suddenly and then disappear.
Black Americans have a higher incidence of sarcoidosis and black women develop it twice as often as black men. It usually develops between the ages of 20-40. Treatment involves immune suppressive drugs like hydrocortisone.
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