Challenging Mimickers in the Diagnosis of Sarcoidosis: A Case Study

Abstract

Sarcoidosis is a systemic granulomatous disease of unknown cause characterized by a wide variety of presentations. Its diagnosis is based on three major criteria: a clinical presentation compatible with sarcoidosis, the presence of non-necrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. Many conditions may mimic a sarcoid-like granulomatous reaction. These conditions include infections, neoplasms, immunodeficiencies, and drug-induced diseases. Moreover, patients with sarcoidosis are at risk of developing opportunistic infections or lymphoma. Reliably confirming the diagnosis of sarcoidosis and better identifying new events are major clinical problems in daily practice. To address such issues, we present seven emblematic cases, seen in our department, over a ten-year period along with a literature review about case reports of conditions misdiagnosed as sarcoidosis.

Tuberculous Meningitis or Neurosarcoidosis—a Diagnostic Quandary

“…Diagnostic errors, defined as missed or delayed diagnoses, have been reported in sarcoidosis. 16 , 18 , 19 In most, the diagnostic error derives from difficult diagnostic nature of CNS granulomatous disorders and the consideration of an alternative diagnosis based on disease progression and results from further testing. The absence of TB from brain tissue staining, the lack of response to repeat TB treatment, and the worsening neurologic progression prompted considerations of alternative diagnoses.…”

Sarcoid‑like granulomatous inflammation in a carotid body paraganglioma: A case report and mini‑review of the literature

“…A number of granulomatous conditions are able to mimic sarcoidosis, clinically and histologically, including sarcoid-like granulomatous reactions, infectious granulomatous diseases, granulomatous drug reactions, neoplastic disorders, immunodeficiencies and systemic disorders with granulomatous characteristics (Rosai-Dorfman disease and Blau syndrome) (8,16). Distinguishing SLGIs from actual sarcoidosis requires a careful review of a patient's complaints, demographics, medical history, clinical examination, laboratory findings, imaging and histological features.…”

“…Distinguishing SLGIs from actual sarcoidosis requires a careful review of a patient's complaints, demographics, medical history, clinical examination, laboratory findings, imaging and histological features. Some clinical characteristics may immediately eliminate the diagnosis of sarcoidosis due to atypical characteristics, such as an age <25 years or >45 years, a high fever, acute or subacute dyspnea and hemoptysis (16).…”

The Elusive Sarcoidosis, an Eight-Year Journey to the Diagnosis of Sarcoidosis: A Case Report

“…Additionally, diagnostic tests are often suggestive rather than pathognomonic. Although there are many cases in the English literature reflecting difficult diagnosis, this case illustrates a unique and challenging presentation of sarcoidosis because of chronic, fluctuating, diffuse LAD with a nonresponse to steroids [6][7][8]. Prognosis of the disease often relies on a variety of factors including organ involvement, response to medications, race, and age [9].…”