The Gray Area of Sarcoidosis and Tuberculosis: A Diagnostic Enigma

This case report presents a challenging diagnostic enigma, where a 29-year-old male patient presented with symptoms and signs favoring both tuberculosis (TB) and sarcoidosis. The patient's plain chest radiograph showed bilateral hilar opacities, while a contrast-enhanced computed tomography (CECT) scan revealed multiple mediastinal and hilar lymph nodes. Histopathology of a mediastinal lymph node biopsy showed necrotizing granulomatous inflammation, favoring TB. However, the patient's symptoms did not resolve with antitubercular treatment, and further investigations revealed a working diagnosis of pulmonary sarcoidosis. The patient's symptoms improved with corticosteroid therapy, and subsequent plain chest radiographs and high-resolution computed tomography (HRCT) scans showed near complete resolution of lung infiltrates. This case highlights the importance of careful evaluation and interpretation of biopsy results and the use of advanced diagnostic techniques to diagnose and differentiate between TB and sarcoidosis accurately.