Restrictive lung diseases Quiz: Ace Your Exams

A 37-year-old African American woman presents to her primary care physician with burning and redness of her left eye. She reports onset of symptoms approximately one week ago, but on review of systems, she also reports chronic fatigue, shortness of breath, cough, and a 4.5-kg (10-lb) weight loss over the past 3 months. She has no significant past medical history, but she states her mother has an “autoimmune” disorder; she is unsure of the details. She does not smoke or use illicit drugs and has not traveled recently. Temperature is 37°C (98.6°F), pulse is 91/min, respirations are 14/min, blood pressure is 130/94 mmHg, and oxygen saturation is 95% on room air.  Physical examination reveals red, hard, painful lumps over the anterior shins. Ocular examination of the left eye is depicted below:  


Reproduced from: Wikipedia    

This patient’s clinical presentation is most likely associated with which of the following pathological features?