Tuberc Respir Dis.  2009 Apr;66(4):309-313.

A Case of Sarcoidosis That Was Initially Misdiagnosed as Nontuberculous Mycobacteria Pulmonary Disease

• Choi HH
• Hong YA
• Choi JK
• Kim JS
• Kim SJ
• Kim SC
• Lee SY
• Kim YK
• Park SH
• Kim TJ
• Lee KY
• Park HJ
• Kim HL
• Ahn MI

Abstract

There are several respiratory diseases that show chronic granulomatous inflammation for the histologic finding. Among them, sarcoidosis and tuberculosis are not easy to differentiate when the clinical and radiological features present similar patterns. The increasing incidence of nontuberculous mycobacteria pulmonary disease is making it more difficult for clinicians to arrive at a proper diagnosis. A 69 year old male patient visited our hospital with chronic cough as his chief compliant. His radiologic findings were multiple enlarged mediastinal lymphadenpathies with innumerable micronodules and multiple patch infiltrations. The spleen biopsy finding showed chronic granulomatous inflammation, and Mycobacterium avium was identified on the bronchoscopic culture. Because of these findings, we treated him with drugs for nontuberculous mycobacteria disease other than sarcoidosis. However, during the treatment, his symptoms and radiological features became aggravated. Thus, we reviewed the radiologic and pathologic findings and decided to treat him with steroid, which relieved his symptoms and improved the radiologic findings. We report here on a case of sarcoidosis that was initially misdiagnosed as nontuberculous mycobacteria pulmonary disease.

Keyword

Sarcoidosis; Nontuberculous mycobacteria pulmonary disease; Chronic granulomatous inflammation

MeSH Terms

Biopsy
Cough
Humans
Incidence
Inflammation
Lung Diseases
Male
Mycobacterium avium
Nontuberculous Mycobacteria
Sarcoidosis
Spleen
Tuberculosis

Figure

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  Figure 1 His initial chest X-ray showed multiple ill-defined nodular opacities with patch consolidations in both lung fields.

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  Figure 2 His initial chest CT scan showed several enlarged mediastinal lymph nodes with innumerable discrete micronodules with some patch infiltrations in both lung fields. Multiple small hypodense nodules were also seen in the enlarged spleen.

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  Figure 3 A spleen biopsy reveals diffuse granulomatous inflammation with some multinucleated giant cells in the fibrotic background (H&E stain, A: ×100, B: ×200).

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  Figure 4 (A) Before steroid treatment, previously noted multiple enlarged mediastinal lymph nodes with innumerable discrete micronodules with some patch infiltrations were increased. Splenic lesions were also increased in size and number, resulting in advanced splenomegaly. (B) After steroid treatment, multiple enlarged nodes with lung infiltrations were decreased in size and number. Also splenic lesions were significantly decreased in size and number.

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