Mycobacterium intracellulare presenting as a sarcoid-like illness

A combined infection with Mycobacterium intracellulare and histoplasmosis in a patient with end-stage sarcoidosis is reviewed. A healthy skepticism should be applied to all but the most classic cases of sarcoidosis. Prolonged follow-up with repeated attempts to demonstrate a specific causative agent will decrease the possibility of overlooking treatable infections. An initial work-up of a patient with sarcoidosis includes fungal immunologic tests, which if positive can lead to further investigation and the correct diagnosis. Steroids should be reserved for clear indications in sarcoidosis. Any exacerbation of an underlying bronchopulmonary disease should compel a search for an infectious cause. This patient responded to amphotericin and three antituberculous drugs but nevertheless had significant sequelae of her illness.