Case Report: Sarcoidosis or tuberculosis? A continuous challenge

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by the formation of non-caseating granulomas in affected tissues and organs. In over half of the cases, the disease undergoes spontaneous remission. In contrast, tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis , which, if left untreated, can be fatal. Sarcoidosis and tuberculosis exhibit numerous overlapping clinical, radiological, and histopathological features, including the presence of epithelioid cell granulomas with multinucleated giant cells. Historically, a potential etiological role of M. tuberculosis in sarcoidosis has been proposed; however, this hypothesis has not been conclusively supported by current evidence or therapeutic outcomes. Differentiating between these two entities presents a significant diagnostic challenge, particularly in regions with a high prevalence of tuberculosis. The diagnostic complexity is further heightened in cases where a concomitant occurrence of both conditions is suspected. In such scenarios, the absence of a definitive biomarker hampers the ability to discern whether the diseases coexist independently or share a pathogenic link. This article reviews current evidence on the association between sarcoidosis and tuberculosis and explores potential pathways to elucidate their etiological interrelationship.