Tuberculosis Lymphadenitis in a Well Managed Case of Sarcoidosis.
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Date
2013-10
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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.
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Keywords
Tuberculosis, Sarcoidosis, Lymph node, Acid-fast bacilli, Corticosteroid treatment
Citation
Mohapatra R P, Garg Kranti, Singhal Niti, Aggarwal D, Gupta R, Khurana A, Janmeja A K. Tuberculosis Lymphadenitis in a Well Managed Case of Sarcoidosis. The Indian Journal of Chest Diseases and Allied Sciences, 2013 Oct; 55(4): 217-220.