Sarcoidosis and Tuberculosis: A Case Report and Literature Review

Abstract

We present a 52-year-old Iraqi female patient who presented with extensive bilateral pulmonary micronodules on a chest X-ray (CXR) after a recent month-long visit to Turkey. She had a history of sarcoidosis, diagnosed 2 years ago, and was initially treated with a tapering dose of prednisone and maintained on a high dose of inhaled budesonide. High resolution computed tomography of the chest showed the new development of pulmonary nodules in a miliary pattern. Infectious causes were excluded with bronchoalveolar lavage. Non-necrotizing granulomatous inflammation and a lymphocyte count of 29% were obtained from a transbronchial lung biopsy and the differential cell count of the bronchoalveolar lavage, respectively. The patient started a treatment regimen of methotrexate and prednisone. Her repeat CXR at a subsequent follow up session showed resolution of the pulmonary micronodules. The association between sarcoidosis and tuberculosis was discussed. Published cases of miliary pulmonary nodules were examined for association with tuberculosis. To date, there has been no definitive evidence of tuberculosis as a cause for sarcoidosis despite the reported association. This case report emphasizes that sarcoidosis patients with pulmonary miliary patterns may have underlying risk factors for tuberculosis, and calls for more investigations to be performed to further delineate the association.