Tuberculosis and Sarcoidosis Overlap: A Clinical Challenge From Diagnosis to Treatment

Abstract

Tuberculosis (TB) and sarcoidosis have clinical, immunologic, and radiologic similarities and the differential diagnosis is often a challenge. Some cases are described in which patients have both diseases concomitantly. There is a hypothesis that posits TB and sarcoidosis as being along the spectrum of the same disease. This has important implications for treatment decisions, since immunosuppression, which is a treatment for sarcoidosis, is undesirable in TB patients. We are going to describe a clinical case of a TB patient who developed more severe symptoms during the course of TB treatment and, after excluding TB progression or resistance, he was diagnosed as probable sarcoidosis. He was started on immunosuppression, with great improvement, finishing the TB treatment completely asymptomatic.

Keywords: granulomata; immunosuppression; mycobacterium; sarcoidosis; tuberculosis.

Figure 1. Chest radiogram showed extensive consolidation in the right upper lobe (white arrow) and right hilar lymphadenopathy (blue arrow).

Figure 2. Chest CT scan A) at the diagnosis, showed right upper and middle zone parenchymal infiltrate (white arrows) and extensive mediastinal adenopathy (blue arrow); B) Worsening symptoms, showed a widespread miliary pattern (green arrow) with extensive involvement.

CT - computed tomography