Coexistence of pulmonary tuberculosis and sarcoidosis: a diagnostic dilemma

Mandal, S. K.; Ghosh, Sudip; Mondal, Soumya; Chatterjee, Sumanta

doi:10.1136/bcr-2014-206016

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…It is notable that there was detection of inhA in 59% of the subjects with sarcoidosis, suggesting that the use of isoniazid would be a potential therapeutic agent in these subjects, serving as the backbone of latent and active tuberculosis therapy. Sarcoidosis and tuberculosis can coexist within the same host (22)(23)(24)(25). Interestingly, studies have demonstrated the appearance of sarcoidosis after completion of tuberculosis therapy (26,27) However, the ability to detect DNA encoding potential targets of antimicrobials does not ensure that such antimicrobials would be active against the bacilli.…”

Section: Discussionmentioning

confidence: 99%

Molecular Analysis of Sarcoidosis Granulomas Reveals Antimicrobial Targets

Rotsinger

Celada

Polosukhin

et al. 2016

Am J Respir Cell Mol Biol

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Sarcoidosis is a granulomatous disease of unknown cause. Prior molecular and immunologic studies have confirmed the presence of mycobacterial virulence factors, such as catalase peroxidase and superoxide dismutase A, within sarcoidosis granulomas. Molecular analysis of granulomas can identify targets of known antibiotics classes. Currently, major antibiotics are directed against DNA synthesis, protein synthesis, and cell wall formation. We conducted molecular analysis of 40 sarcoidosis diagnostic specimens and compared them with 33 disease control specimens for the presence of mycobacterial genes that encode antibiotic targets. We assessed for genes involved in DNA synthesis (DNA gyrase A [gyrA] and DNA gyrase B), protein synthesis (RNA polymerase subunit β), cell wall synthesis (embCAB operon and enoyl reductase), and catalase peroxidase. Immunohistochemical analysis was conducted to investigate the locale of mycobacterial genes such as gyrA within 12 sarcoidosis specimens and 12 disease controls. Mycobacterial DNA was detected in 33 of 39 sarcoidosis specimens by quantitative real-time polymerase chain reaction compared with 2 of 30 disease control specimens (P < 0.001, two-tailed Fisher's test). Twenty of 39 were positive for three or more mycobacterial genes, compared with 1 of 30 control specimens (P < 0.001, two-tailed Fisher's test). Immunohistochemistry analysis localized mycobacterial gyrA nucleic acids to sites of granuloma formation in 9 of 12 sarcoidosis specimens compared with 1 of 12 disease controls (P < 0.01). Microbial genes encoding enzymes that can be targeted by currently available antimycobacterial antibiotics are present in sarcoidosis specimens and localize to sites of granulomatous inflammation. Use of antimicrobials directed against target enzymes may be an innovative treatment alternative.

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Section: Discussionmentioning

confidence: 99%

Molecular Analysis of Sarcoidosis Granulomas Reveals Antimicrobial Targets

Rotsinger

Celada

Polosukhin

et al. 2016

Am J Respir Cell Mol Biol

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“…A detailed clinical history and histologic correlation are therefore essential for differentiating tuberculous myocarditis from sarcoidosis. It has also been observed as reported in previous studies that both sarcoidosis and TB can coexist, 19 20 causing diagnostic dilemma and the presence of both disease conditions in the same patient does not exclude each other and need to considered. At the time of writing this case report, antitubercular treatment had been initiated and the importance of follow-up imaging has been explained to monitor treatment response.…”

Section: Discussionmentioning

confidence: 93%

Cardiac Tuberculosis on 18F-FDG PET Imaging—A Great Masquerader of Cardiac Sarcoidosis

Sundaraiya

Sulaiman

Rajendran

2021

Indian J Radiol Imaging

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A young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.

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“…Notably, some studies have suggested that patients with TB or SA should be further divided into four subtypes: sarcoidosis (SA), sarcoid-tuberculous (ST), tuberculous-sarcoid (TS), and tuberculosis (TB) (Agrawal et al, 2016;Mandal et al, 2014). This classification method implies that MTB may also exist in patients with SA and indicates a great risk of dissemination of TB lesions after hormone treatment.…”

Section: Discussionmentioning

confidence: 99%

Rapid discrimination between tuberculosis and sarcoidosis using next-generation sequencing

Chao

Gong

et al. 2021

International Journal of Infectious Diseases

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Objectives: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (MTB), has similar clinical, radiological, and histopathological characteristics to sarcoidosis (SA). Accurately distinguishing SA from TB remains a clinical challenge. Methods: A total of 44 TB patients and 47 SA patients who were clinically diagnosed using chest radiography, pathological examination, routine smear microscopy, and microbial culture were enrolled in this study. The MTB genome was captured and sequenced directly from tissue specimens obtained upon operation or biopsy, and the feasibility of next-generation sequencing (NGS) for the MTB genome in the differential diagnosis of TB from SA was evaluated. Results: Using a depth >10Â and coverage >15% of the sequencing data, TB patients were identified via the NGS approach directly using operation or biopsy specimens without clinical pretreatment. The sensitivity, specificity, and concordance of the NGS method were 81.8% (36/44), 95.7% (45/47), and 89.0% (81/91), respectively (kappa = 0.78, 95% confidence interval 0.65-0.91; P < 0.001). Conclusions: This study established an improved NGS strategy for rapidly distinguishing patients with TB from those with SA and has potential clinical benefits.

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Coexistence of pulmonary tuberculosis and sarcoidosis: a diagnostic dilemma

Cited by 11 publications

References 12 publications

Molecular Analysis of Sarcoidosis Granulomas Reveals Antimicrobial Targets

Molecular Analysis of Sarcoidosis Granulomas Reveals Antimicrobial Targets

Cardiac Tuberculosis on 18F-FDG PET Imaging—A Great Masquerader of Cardiac Sarcoidosis

Rapid discrimination between tuberculosis and sarcoidosis using next-generation sequencing

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