Tuberculosis or Sarcoidosis or the Both? A Case Report of Concomitant Tuberculosis and Sarcoidosis

Abstract

Tuberculosis and sarcoidosis are two chronic granulomatous diseases that are similar in many aspects, although different.

We report a case of 38-year-old female patient who presented a progressive shortness of breath and recurrent epistaxis associated to a night sweats and fatigue with a deterioration of general condition, in which a CT-scan showed a multiple voluminous lymphadenopathy involving all the mediastinum territories, without parenchymal abnormalities. During investigations bronchoscopy showed mucosal hypertrophy and granulations located on the nasopharyngeal walls. The biopsy of the lip and nasal’s lesion showed a non-caseating granuloma and ACE (angiotensin converting enzyme) was high, which considered sufficient to retain the diagnosis of sarcoidosis, but the blood Quantiferon-TB Gold in Tube test was positive and the excision biopsy of cervical lymphadenopathy, revealed a necrotizing granulomatous inflammation suggestive of tuberculosis. The association between sarcoidosis and tuberculosis was discussed. the patient was treated with antituberculosis drugs during six months. The evolution was marked by a progressive regression of lymph nodes. There was no significant improvement of rhinological symptoms with local corticoids. Consequently, the corticosertoide treatement in form oral was introduced during 1 month. The prednisolone was gradually tapered off after 1 month due to the complete disappearance of lesions.

The case described is suggestive of a coexistent systemic sarcoid manifestation and tuberculosis, which is an underrecognized entity in the medical literature.