Case Report: Sarcoidosis or tuberculosis? A continuous challenge

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by the formation of non-caseating granulomas in affected tissues and organs. In over half of the cases, the disease undergoes spontaneous remission. In contrast, tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, which, if left untreated, can be fatal. Sarcoidosis and tuberculosis exhibit numerous overlapping clinical, radiological, and histopathological features, including the presence of epithelioid cell granulomas with multinucleated giant cells. Historically, a potential etiological role of M. tuberculosis in sarcoidosis has been proposed; however, this hypothesis has not been conclusively supported by current evidence or therapeutic outcomes. Differentiating between these two entities presents a significant diagnostic challenge, particularly in regions with a high prevalence of tuberculosis. The diagnostic complexity is further heightened in cases where a concomitant occurrence of both conditions is suspected. In such scenarios, the absence of a definitive biomarker hampers the ability to discern whether the diseases coexist independently or share a pathogenic link. This article reviews current evidence on the association between sarcoidosis and tuberculosis and explores potential pathways to elucidate their etiological interrelationship.