Tuberculosis sarcoidosis: case study from a tribal district

Abstract

Sarcoidosis is an under diagnosed disease in India, probably due to the close resemblance to tuberculosis and the lack of awareness. Sarcoidosis is a multiorgan granulomatous disease, the most common head and neck manifestation of which is cervical lymphadenopathy is most common. 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 woman, with a proven diagnosis of sarcoidosis and TB. A 32 year old female patient presented with low-grade fever since nine 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 and high resolution computed tomography revealed no abnormal findings. The patient was treated with antibiotics and followed-up. She again presented with persistence of fever and lymphadenopathy and difficulty in swallowing. Her repeat Monteux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. The local quack had some operation in that cervical lymph node present in anterior and posterior triangle of neck which leads to sinus formation from oesophagus. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. She 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.