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We read with interest the lesson of the month “Sarcoidosis: TB or not TB?” by Litinsky and colleagues, published in the May 2002 issue of the Annals of the Rheumatic Diseases.1
We, in India, face the reverse problem. With us tuberculosis (TB) is still a scourge. Sarcoidosis in India, though not unknown, is definitely rare in comparison with TB. Because non-caseating granulomas can occur in TB also, a diagnosis of TB is accepted even if acid fast bacilli are not demonstrated or grown in culture. For these reasons, many patients with sarcoidosis are initially treated for TB before the eventual diagnosis is made.2
The risk of a patient receiving corticosteroids developing TB depends on the dose and duration of the corticosteroid treatment. Our group has reported a high incidence of TB in patients with systemic lupus erythematosus receiving corticosteroid treatment.3
The patient in question undoubtedly had both sarcoidosis and TB, the latter probably the result of corticosteroid treatment. In our experience most patients develop TB in the first year of such corticosteroid treatment.3 We advocate routine isoniazid prophylaxis for patients receiving long term corticosteroid treatment.4
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