A 44-year-old woman was presented with shortness of breath with H/O childhood asthma and type 2 DM. She experienced weight loss, night sweats and worsened dyspnoea after being treated with prednisolone. Hilar lymphadenopathy with a large mass in the left lower lobe was revealed on evaluation. In addition, a CT-guided lung biopsy revealed a non-necrotic multifocal granuloma with multinucleated giant cells. This finding could represent a reaction secondary to an occult malignancy. However, the mediastinoscopy and bronchoscopy tests revealed granulomatous inflammation without the presence of malignancy or infection. Based on these findings, she was treated with high-dose prednisone and insulin therapy (to control hyperglycemia). After three months, she reported improvement in her dyspnoea, repeat CT and biopsy revealed a significant decrease in lung mass size and lymphadenopathy. Hence, she was continued on a prednisone taper.
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