© 2002 by Annals of the Rheumatic Diseases
LESSON OF THE MONTH
Sarcoidosis: TB or not TB?
Series editor: Anthony D Woolf
1 Department of Rheumatology, Tel Aviv "Sourasky" Medical Centre, Israel
2 Department of Radiology, Tel Aviv "Sourasky" Medical Centre
3 Shmuel Harofe Geriatric Medical Centre and Tel Aviv University, Tel Aviv, Israel
Correspondence to:
Correspondence:
Dr I Litinsky, Department of Rheumatology, Tel Aviv Sourasky Medical Centre, 6 Weizmann Street, Tel Aviv 64239, Israel
Accepted 28 Aug 2001
Keywords: sarcoidosis; tuberculosis
Abbreviations: MRI, magnetic resonance imaging; PCR, polymerase chain reaction; PPD, purified protein derivative
A 37 year old man presented at another centre with a three week history of high grade fever, chills, and cervical lymphadenopathy. Routine laboratory tests as well as a purified protein derivative (PPD) test were within the normal ranges. Computed tomography of the chest and abdomen showed massive lymphadenopathy in the mediastinum and retroperitoneum. A cervical lymph node biopsy disclosed non-caseating granuloma negative for Mycobacterium tuberculosis by acid fast staining and culture. Sarcoidosis was diagnosed and the patient was treated with corticosteroids at a maximum dose of 60 mg/day for two months with complete resolution of the fever and lymphadenopathy.
Four months later, the patient developed right carpal tunnel syndrome, which was attributed to a lesion occupying space in the right radius; the tumour was removed and histology demonstrated non-caseating granuloma, interpreted as osseous sarcoidosis. A short course of corticosteroids was renewed and tapered off. He remained asymptomatic during the
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Gaitonde, S D, Balakrishnan, C, Joshi, V R
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