A rare case of Tuberculous Sarcoidosis

Tuberculosis & Sarcoidosis are complex chronic granulomatous diseases which are quite different but are similar in many aspects & their conjoint occurrence have been seen in very few cases rarely. Share your views on this rare case of Tuberculous Sarcoidosis by Dr. Viral Patel & learn the art of diagnosing complex diseases. Follow us for such updates!

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An exhaustive and comprehensive presentation of Curofy Expert Clinical case by Dr Viral Patel - a really informative case Patient was lucky to have his ACE levels raised to 143 - although few patients have even normal ACE levels. It is one of the rare cases of disseminated tuberculosis Co- existing with sarcoidosis Distinguishing sarcoidosis from pulmonary tuberculosis can sometimes be a great challenge to physicians, especially in developing countries where there is high prevalence of tuberculosis. Both tuberculosis and sarcoidosis are granulomatous diseases, however, tuberculosis has a caseating granuloma as opposed to sarcoidosis, which present with non-caseating epithelioid cell granuloma. Due to the marked clinico-radiological similarity of these entities and high prevalence of tuberculosis, these patients receive repeated courses of anti-tubercular therapy (ATT) while lung damage continues to progress. Thanks Dr Viral Patel for this case and a young male was prevented from lung damage

Thanks sir
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Absolutely sarcoidosis is under diagnosed and still rarely thought along with tuberculosis In given case it was still more difficult when the pt is covid positive as most comoonly seen is pulmonary fibrosis but you thought otherwise and marker like SACE considered and found positive But limitations of treatment are to depend on steroids Thanx for sharing a well informed case

Thanx dr Binod Bihari Mahto
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Steroids are not for purpose of tuberculosis here, it's for coexisting Sarcoidosis. Steroids in tuberculosis are useful in following conditions :- 1)Tubercular Pleural effusion 2)Tubercular Meningitis 3)Tubercular pericarditis 4)Associated Adrenal insufficiency 5)IRIS/Paradoxical response 6)Co-existence of Sarcoidosis or other autoimmune disease

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thanks so much Team Curofy..
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NICE ILLUSTRATION OCCULAR COMMENTS IF SARCOIDOSIS ARE ANT SEGMENTAL MANEFESTATIONS POST SEGMENT MANEFESTATIONS ANT SEGMENT ARE SARCIOD PLAQUES LIKE CHLAZIA LACRIMAL GLAND INVOLVEMENT FOLLICULAR CONJUCTIVITS PHELETENULAR CONJUCTIVITS HETROCHROMIA IRIS NODULE SCLERITIS BIL GRANULOMATOUS PANUVEITIS ACUTE UVEITIS 40 PERCENT 60 PERCENT CHRONIC UVEITIS POST SEGMENT MANEFESTATIONS PRE RETINAL MODULE CHORIODAL INVOLVEMENT CANDLE WAX APPEARANCE PERIVASCULITIS VENOUS OCLUSION GRANULOMA.OF DISC GRANULOMA OF RETINA

It's a case to enlighten us regarding under noticed Sarcoidosis in TB endemic zones like India. Co-existence is also under noticed in similar way. We need to keep high index suspicion for this sort of scenario. We need to guide our management as per Histopathological opinion along with radiological guidance. Markers like ACE level are very helpful in such issues.

CAUSES OF BILATERAL GANULOMATOUS PANUVEITIS THEY ARE 1 S OPHTHALMIC 2 V K H DESEASE 3 BECHETES DESEASE 4 SARCIODISIS 5 H I V 6 TUBERCULOSIS 7 SYPHLIS 8 INFECTIVE ENDOPHTHALMITIS 9 ABSTEIN BAR VIRUS

Excellent , to the point explanation showing salient features of tuberculosis & sarcoidosis & tuberculous sarcoidosis.

Nice case presentation.indeed sarcoidosis is never considered in association with tuberculosis.really very helpful.

Thanks Dr
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Really a very informative case presentation by Dr Viral patel . But as in starting slides it is mentioned that Patient was also recieving steroids with other treatment. But was not improvement but he diagnosed histopathologically sarcoidosis then improvement seen on prednisolone so i want to know that is it only prednisolone as steroid got result in sarcoidosis or we can use any steroid as so many forms available if yes then why Patient was not improving during Admission earliar when he was recieved steroid too with other treatment. Please exlain Dr patel please? Thanks

When patient was admitted at Government Covid facility, they used steroid for a short time probably 5 days. Later on discharged from COVID. But even after discharge he continued to have fever and Dry Cough which was worked up by me n my time during post COVID consultation. And then ATT f/by STEROIDS gave a magic bullet response.
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