Diagnostic Challenges in Granulomatous Uveitis: Tuberculosis or Sarcoidosis?

Abstract

Purpose: To emphasize the challenge in the diagnosis of granulomatous uveitis, distinguishing clinical, laboratory, and histological features of tuberculosis, sarcoidosis, and borderline entities. Methods: Case report. Results: A patient coming from tuberculosis endemic area with granulomatous uveitis and generalized lymphadenopathy was first diagnosed with possible intraocular tuberculosis, based on the presence of suggestive clinical signs, caseous central necrosis in lymph node biopsy, and documented exposure to TB. Lack of response to antitubercular therapy together with laboratory test results, radiological and histological findings and negative biopsies for Mycobacterium tuberculosis led to the diagnosis of tuberculous-sarcoidosis. Conclusions: The diagnosis and correct therapeutic strategy of entities that fall in between tuberculosis and sarcoidosis still remains challenging, especially in patients coming from endemic areas.

Keywords: Granulomatous; sarcoidosis; tuberculosis; tuberculous sarcoidosis; uveitis.