Sarcoidosis in tuberculosis-endemic regions: India

Abstract

Sarcoidosis is a multisystem inflammatory disease of unknown etiology affecting multiple organs. Earlier reports suggested that sarcoidosis was a disease of the developed world. However, recent reports suggest that the disease is found in the developing countries as well. Clinical, radiological, and histopathological similarities with tuberculosis pose a great challenge in countries endemic for tuberculosis. Mantoux test, high resolution computed tomography, and transbronchial lymph node and lung biopsies are diagnostic modalities, which play an important role in the diagnosis of sarcoid. In this review, we look at the epidemiology of sarcoid in tuberculosis-endemic regions, the sarcoidosis-tuberculosis link, clinical profile, diagnostic modalities, dilemma in the diagnosis, and the treatment of this disease.

Figure 1

Slit lamp photograph showing the conjunctival granulomas in a patient with thoracic sarcoid.

Figure 2

Slit lamp photograph showing the scleral nodule in a patient with sarcoidosis.

Figure 3

Slit lamp photograph showing the granulomatous anterior uveitis with large Koeppe nodules.

Figure 4

Fundus photograph showing vitritis with snow ball opacities in the peripheral retina.

Figure 5

Fundus photograph showing the perivasculitis.

Figure 6

Fundus photograph showing the disc edema.

Figure 7

Fundus photograph showing the optic nerve granuloma.

Figure 8

Fundus photograph showing the choroidal granulomas.

Figure 9

Fundus photograph showing the peripheral chorioretinal punched out scars in a patient with sarcoidosis.

Figure 10

Fundus photograph showing the optic nerve head anastomosis in a patient with cutaneous sarcoidosis.

Figure 11

High resolution computed tomography of the orbits showing bilateral lacrimal gland enlargement.

Figure 12

Chest X-ray showing bilateral hilar lymphadenopathy in a patient with sarcoidosis.

Figure 13

High resolution computed tomography of the thorax showing mediastinal lymphadenopathy in a patient with grade 2 sarcoid with respiratory symptoms.

Figure 14

External photograph of sarcoid granuloma on the face.

Figure 15

Photomicrograph of biopsy from lacrimal glands showing non-caseating granulomas with giant cells.