[Tuberculosis or sarcoidosis]

Tuberculosis and sarcoidosis are two different diseases with different etiology, clinical features and treatment. Both are granulomatous disease, but tuberculosis has a caseating necrosis granuloma as opposed to sarcoidosis witch present noncaseating epithelioid cell granuloma. If chest radiography shows hilar lymphadenopathy and hystopatological features reveal no caseating necrosis granuloma the differential diagnosis might be difficult. This is a case of abdominal adenopathy in a 39-years-old male, with a past medical history significant for pulmonary tuberculosis. The patient was admitted to the hospital for mild epigastric pain and weight loss (14 kg for the last year). The abdominal ultrasound and CT scan revealed retroperitoneal lymph node enlargement. Chest X-ray revealed bilateral hilar adenopathy and mediastinal adenopathy. After various differential diagnoses were considered, a diagnostic laparoscopy and a lymph node biopsy were performed. The pathology report showed chronic necrotizing granuloma. The case was interpreted as lymph node sarcoidosis and treated with corticosteroids (Prednisone). After one month of treatment the patient complained of dry cough, night sweats, fatigability, decreased appetite and weight loss. Pathological findings of chest radiography and CT scan with iv contrast (left upper lobe infiltrate, right lower lobe ill-defined mass, multiple small nodular opacities scattered throughout both lung fields, bilateral hilar and mediastinal adenopathy, lymph nodes near celiac trunk were enlarged) and positive acid-fast bacilli of sputum smears point to the real diagnosis of pulmonary tuberculosis and abdominal lymph nodes tuberculosis. The patient was started on a daily treatment with Isoniazid, Pyrasinamide, Ethambutol, Streptomycine, Cyprofloxacine, Cicloserine and Protionamide (he was allergic to Rifampin). Five months later the clinical and radiological findings were almost normal and the sputum smear for acid-fast bacili was negative.