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• coexistence of tuberculosis and sarcoidosis needs to be ruled out
  oscar,m jolobe
  Published on: 21 January 2020

• Published on: 21 January 2020

  coexistence of tuberculosis and sarcoidosis needs to be ruled out

  • oscar,m jolobe, retired geriatrician manchester medical society

  Given the fact that tuberculosis and sarcoidosis have many stigmata in common (including the occurrence of noncaseating granulomas), a diagnosis of multiorgan sarcoidosis (1) can only be established beyond doubt if care has been taken to rule out the coexistence of sarcoidosis and tuberculosis using the strictest criteria for ruling in or for ruling out tuberculosis. Evaluating tissue samples for M tuberculosis through the use of the polymerase chain reaction (PCR) is one such strategy, given the fact that sensitivity for M tuberculosis infection is significantly higher for PCR than for BACTEC radiometric culture (74.4% vs 55.8%), although the two modalities have comparable specificity, namely, 97.2% vs 100% (no significant difference) (2). Accordingly, when the authors state "All biopsy specimens and bronchial washings were negative for TB (1), we need to know whether those samples were subjected either to mycobacterial culture or to evaluation by PCR.
  The coexistence of sarcoidosis and tuberculosis was documented unequivocally in a 35 year old woman who initially presented with histologically and bacteriologically confirmed tuberculous lymphadenitis. She subsequently developed bilateral lung infiltrates. Histological specimens obtained via transbronchial biopsy and open lung biopsy showed features consistent with sarcoidosis. In addition, however, the presence of mycobacterial DNA in those tissue specimens was documented by PCR (3).
  In another report, a...

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  Given the fact that tuberculosis and sarcoidosis have many stigmata in common (including the occurrence of noncaseating granulomas), a diagnosis of multiorgan sarcoidosis (1) can only be established beyond doubt if care has been taken to rule out the coexistence of sarcoidosis and tuberculosis using the strictest criteria for ruling in or for ruling out tuberculosis. Evaluating tissue samples for M tuberculosis through the use of the polymerase chain reaction (PCR) is one such strategy, given the fact that sensitivity for M tuberculosis infection is significantly higher for PCR than for BACTEC radiometric culture (74.4% vs 55.8%), although the two modalities have comparable specificity, namely, 97.2% vs 100% (no significant difference) (2). Accordingly, when the authors state "All biopsy specimens and bronchial washings were negative for TB (1), we need to know whether those samples were subjected either to mycobacterial culture or to evaluation by PCR.
  The coexistence of sarcoidosis and tuberculosis was documented unequivocally in a 35 year old woman who initially presented with histologically and bacteriologically confirmed tuberculous lymphadenitis. She subsequently developed bilateral lung infiltrates. Histological specimens obtained via transbronchial biopsy and open lung biopsy showed features consistent with sarcoidosis. In addition, however, the presence of mycobacterial DNA in those tissue specimens was documented by PCR (3).
  In another report, a 43-year-old woman who had initially presented with erythema nodosum, cough, and bacteriologically proven evidence of pulmonary tuberculosis, subsequently developed biopsy proven stigmata of cutaneous sarcoidosis. Radiological stigmata of sarcoidosis included hilar lymphadenopathy and a reticular interstitial pattern in the lower zones. Histopathological findings from lung and bronchial wall biopsy included documentation of noncaseating granulomas. However, M tuberculosis was isolated when the biopsy specimens were cultured. She subsequently developed nodular cutaneous infiltrates on her face, and these were histologically shown to be attributable to sarcoidosis (4).

  I have no funding and no conflict of interest

  References
  (1) Kohli M., Schiller I., Dendukuri N et al
  Xpert MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance(Review)
  Cochrane Database of Systematic Reviews2018; Issue 8. Art No.:CD012768
  (2) Morasert T., Jongjaroonrangsun M., Smithtithiti S., Bhummichitra K
  Sarcoidosis with multiorgan involvement
  Postgrad Med J 2019;doi:10.1136/postgradmedj-2019-137219
  (3)Wong CF., Yew WW., Wong PC., Lee J
  A case of concomitant tuberculosis and sarcoidosis with mycobacterial DNA present in the sarcoid lesion
  CHEST 1998;114:626-629
  (4)Mise K., Goic-Barisic I., Puizina-Ivic N et al
  A rare case of pulmonary tuberculosis with simultaneous pulmonary and skin sarcoidosis: a case report
  Cases Journal 2010;3:24

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  Conflict of Interest:
  None declared.

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