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An unexpected diagnosis of disseminated sarcoidosis in a patient investigated for drug-resistant tuberculosis: a case report

Yeoh, Alastair, Brookfield, Charlotte, Aston, Stephen, Wat, Dennis and Wingfield, Tom ORCID: (2023) 'An unexpected diagnosis of disseminated sarcoidosis in a patient investigated for drug-resistant tuberculosis: a case report'. Clinical Infection in Practice, Vol 20, p. 100244.

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Sarcoidosis can mimic both pulmonary and extrapulmonary tuberculosis (TB). Past TB infection or exposure can lead to diagnostic overshadowing. We present a case of a patient exposed to drug-resistant TB presenting with a multisystem inflammatory syndrome ultimately diagnosed as disseminated sarcoidosis.

Case Report:
A 55-year-old Congolese male with type 2 diabetes presented to clinic with a one-month history of cough. There were no fevers, night sweats or weight loss and a chest radiograph showed bilateral miliary changes. Five years previously his daughters had both been treated for isoniazid and ethambutol resistant TB and he had received preventive therapy with rifampicin and isoniazid. Computed tomography scanning showed diffuse bilateral tiny nodules in the lungs, enlarged mediastinal, hilar and abdominal lymph nodes and splenomegaly. He subsequently developed headache and complex partial seizures. Lumbar puncture and magnetic resonance imaging of the brain were normal. Early diagnostics on induced sputum were inconclusive. One sputum sample detected Mycobacterium tuberculosis DNA, but not to a reportable amplification level and this result was deemed invalid on further testing. Endobronchial ultrasound and mediastinal lymph node biopsy showed histology typical of sarcoidosis with poorly defined, non-caseating granulomas and foci of dystrophic calcification. Tissue staining for mycobacteria and fungi were negative. A serum ACE level was markedly elevated at 264 U/L. The patient was diagnosed with a flare of disseminated sarcoidosis and the illness remitted without immunosuppression.

In patients with a suspected diagnosis of pulmonary or extrapulmonary TB without microbiological confirmation, consider sarcoidosis in the differential diagnosis and consider tissue sampling to support histological differentiation. Molecular tests are increasingly used to diagnose TB and establish TB resistance profiles, but expert knowledge and specialist input regarding the technological pitfalls of molecular tests is essential to guide correct interpretation.

Item Type: Article
Subjects: WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 02 Nov 2023 10:19
Last Modified: 13 Nov 2023 09:34


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