title: Tuberculosis lymphadenitis in a well managed case of sarcoidosis.
abstract: Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.
authors.forename: P R
authors.initials: PR
authors.lastname: Mohapatra
authors.forename: Kranti
authors.initials: K
authors.lastname: Garg
authors.forename: Niti
authors.initials: N
authors.lastname: Singhal
authors.forename: D
authors.initials: D
authors.lastname: Aggarwal
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: A
authors.initials: A
authors.lastname: Khurana
authors.forename: A K
authors.initials: AK
authors.lastname: Janmeja
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D044963:Biopsy, Fine-Needle / Q000379:methods; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents