Coexistence of Sarcoidosis and Tuberculosis Presenting with Severe Pulmonary Artery Hypertension: A Clinical Dilemma

Abstract

Background: Chronic granulomatous conditions affecting the respiratory system such as tuberculosis and sarcoidosis have similar case presentations suggesting them to be polar ends of the same disease spectrum thus putting physicians into a clinical dilemma. This case report highlights one such unique presentation. Case Presentation: A young female, presented with respiratory distress and significant weight loss. Investigations showed severe pulmonary artery hypertension (PAH), renal failure and generalized lymphadenopathy suggesting multisystem involvement. The initial diagnosis was sarcoidosis warranting corticosteroids but since Mantoux test suggested tuberculosis we were in a dilemma regarding therapeutic options. Conclusion: This case highlights a rare presentation of sarcoid tuberculous with severe PAH urging physicians to consider this chronic granulomatous disease spectrum during work up of their patients. The authors would also like to emphasize the importance of starting combined therapy on early recognition to combat a possible disease entity like tuberculous sarcoid patients. These predictors, however, need further work to validate reliability.