title: Sarcoidosis: challenging diagnostic aspects of an old disease.
abstract: Over the past few years, there have been substantial advances in our understanding of sarcoidosis immunopathogenesis. Conversely, the etiology of the disease remains obscure for a number of reasons, including heterogeneity of clinical manifestations, often overlapping with other disorders, and insensitive and nonspecific diagnostic tests. While no cause has been definitely confirmed, there is increasing evidence that one or more infectious agents may cause the disease, although the organism may no longer be viable. Here we present 2 cases, in which sarcoidosis preceded tuberculosis and non-Hodgkin lymphoma. Development of new lesions in a patient with chronic/remitting sarcoidosis should be looked at with suspicion and promptly investigated in order to rule out an alternative/concomitant diagnosis. In such cases, tissue confirmation from the most accessible site, and bone marrow biopsy-if lymphoma is in the differential diagnosis-should be performed. In conclusion, we strongly advise that physicians be ready to reconsider the diagnosis of sarcoidosis in the presence of atypical manifestations or persistent/progressive disease despite conventional therapy.
authors.affiliation: Section of Respiratory Diseases, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy. paolo.spagnolo@unimore.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Spagnolo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Luppi
authors.forename: Pietro
authors.initials: P
authors.lastname: Roversi
authors.forename: Stefania
authors.initials: S
authors.lastname: Cerri
authors.forename: Leonardo Michele
authors.initials: LM
authors.lastname: Fabbri
authors.forename: Luca
authors.initials: L
authors.lastname: Richeldi
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012507:Sarcoidosis / Q000175:diagnosis*; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents