Coexistent Sarcoidosis and Tuberculosis: A Case Report.
Necrotizing granulomatous diseases of the lungs are usually dependent on a narrow range of differential diagnoses. Tuberculosis (TB) is responsible for the largest number of cases, while necrotizing sarcoidosis is generally considered a rare and easily distinguishable disease substantially based on histological features. However, this entity has become a viable diagnosis in the absence of mycobacteria isolation or when a remarkable clinical improvement cannot be achieved with the combination of anti-TB drugs at full dosage. The classic manifestations of TB and sarcoidosis have an overlapping range for which it is sometimes difficult to make a clinical diagnosis. Furthermore, the role of mycobacteria as a trigger antigen capable of evoking the clinical expression of sarcoidosis is a hypothesis supported by evidence from some cases. We report a case of bilateral tuberculous pleurisy in a 45-year-old male native of a North-African region with an atypical severe multisystem disease characterized by a fever resistant to anti-TB therapy and respondent to corticosteroid treatment. The choice to continue both steroid and anti-TB therapy proved to be correct for the late evidence of TB mycobacterial growth only on pleural specimens. The case described is suggestive of a coexistent systemic sarcoid manifestation and low-antigen TB, which is an underrecognized entity in the medical literature.
Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Azienda Ospedaliero Universitaria Foggia, Foggia, Italy.
Cristiano
C
Carbonelli
Ernesto
E
Giuffreda
Antonio
A
Palmiotti
Domenico
D
Loizzi
Filippo
F
Lococo
Elisiana
E
Carpagnano
Donato
D
Lacedonia
Francesco
F
Sollitto
Maria Pia
MP
Foschino
D003937:Diagnosis, Differential; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography; D013902:Radiography, Thoracic; D012507:Sarcoidosis / Q000150:complications* / Q000000981:diagnostic imaging; D014396:Tuberculosis, Pleural / Q000150:complications* / Q000000981:diagnostic imaging