Pulmonary Sarcoidosis Vs TuberculosisIntroduction:
Sarcoidosis with a prevalence of 10/100,000, is a multisystem disease of unknown etiology characterized by non-caseating granulomas.i It involves virtually any organ, lungs, thoracic lymph nodes, skin liver, central nervous system, eyes, kidneys and heart, and is more common in Afro-Americans. There is no sex predilection but some manifestations of the disease are more common is females. ² It begins in the third or fourth decade and tends to be rare in children and the elderly.? We are presenting a case of sarcoidosis of the lungs which should be considered in the differential diagnosis of tuberculosis, common in countries like Pakistan.
Considering the common disease first which is tuberculosis, long-standing history of low grade fever, weight loss and persistent cough not responding to anitibiotics along with raised ESR and positive PPD(13 mm) supports tuberculosis put PPD is not reliable in developing countries as a tool for diagnosis.
Diagnostic procedure performed was an endobronchial biopsy. ² Histopathological examination showed multiple granulomas, composed of epitheloid histiocytes, with occasional Langerhan's giant cell and no necrosis. According to one study endobronchial biopsy increased the yield of fibreoptic bronchoscopy by 20.6%.4 Fungal stain, AFB stains and cultures, were negative (Table II).
The patient had X-ray findings consistent with stage II disease. 1,5 Unilateral hilar adenopathy is an atypical manifestation of sarcoidosis in initial stage. 6 Her ACE level was raised about three folds, serum calcium was in upper normal range and ESR was persistently raised (Table I) supported by radiological findings, which favour sarcoidosis. PPD is negative in sarcoidosis are anergic to PPD tuberculin but distribution of memory T-cells in the blood and humoral immune response are normal and opportunistic infections are rare.¹
Fifty percent of sarcoid cases have clinically silent involvement of organs, which is one of the hallmarks.¹ 20-40% of symptomatic patients have respiratory symtoms and 10-40% have eye pain, rashes arthralgia and other symptoms while 20-30% with constitutional symptoms like weight loss and fatigue.¹
Sarcoidosis may present atypically as Lofgrens and HeerFordt's syndrome.¹ Sarcoidosis in younger patients with spontaneous remission and less than two years duration of symptoms are classified as subacute while chronic form have more than two years duration with insidious onset and presents with constitutional symptoms, pulmonary fibrosis and nephrocalcinosis.¹
In one study in which histopathological diagnosis required presence of non-caseating granuloma, bronchoscopic biopsy yielded diagnosis in 60% of patients with stage I disease, tranbronchial needle aspiration yielded diagnosis in 53% and two procedures in combination yielded 83% of diagnosis. 7,8 In stage II disease probability of obtaining a positive result with a single specimen was 46%, the yielded with more specimens followed a logarithmic curve and increased to 90% with four specimen, at which point the yield approached a plateau for additional specimen. 7,8 The suggests that four biopsy specimens are sufficient to make diagnosis. Biopsy of gastrocnemius muscle is another sensitive and specific tool for diagnosis. 9 If transbronchial biopsies are non-diagnostic, mediastinal lymph node biopsies are diagnostic in 8-90% of case. 10 Finally , the patient was kept on steroids (Deltacortil) 40mg/day in divided doses and He/She responded well with remarkable improvements. 11 His/Her ESR came down to 13mm, chest X-ray showed remarkable improvement as infiltrates and bilateral hilar adenopathy disappeared altogether.
We kept His/Her on the same dose of Deltacortil till 8 weeks, and then it was trapered off to 7.5mg/day without recurrence.
By: Ibrahim Machiwala
Affordable And Happy Housing Alarming Decline In Seal Population All You Need To Know Alternative Treatment For Malaria An Aging Population Calls Out For More Asbestosis Tuberculosis And Alimentary Cancer Cancer Case Control Studies Childrens Show Speaks To A Multicultural Dealing With Tuberculosis (tb) Dependable Strategies To Safeguard Drugs And Medicine Used In Malaria Drugs Used In Malaria For Its Treatment Effective Online Teaching Aids Elder Abuse Alzheimers And Our Aging Four Natural Sleep Aids To Combat Golf Instruction Aids Hearing Aids For Seniors Hiv aids In Africa How To Treat Tuberculosis Naturally I Am Malaria Malaria Symptoms Treatment And Prevention Malaria Travellers Guide Malaria Treatment Cure Malaria Treatment Number One Malaria Centre Overcrowding Population Population Spurs Guwahati Real Estate Powerful Natural Sleeping Aids Simple Pulmonary Sarcoidosis Vs Tuberculosis Should I Begin Using The Devastation Caused By Malaria The Population Control Controversy The Problems Facing Medicare Treatment For Tuberculosis Tuberculosis And 2 Billion People Tuberculosis And Bcg Vaccine Generalities Tuberculosis Drugs Are Useful In Treating Tuberculosis Symptoms Diagnosis And Causes What Should You Do Why Is Tuberculosis Serious Health Diseases
A Buddhist Break in Sri Lanka A Detox Fasting Paradise A New Way to Look Amazing Holidays in Sri Lanka Backpacking Information on Sri Lanka Blue Ocean Strategy Set Your Company Blue Ocean Strategy City Hospitality of the Hotels in Colombo Cruise Lines Exclusive Private Islands Do They Play Cricket Doggin Americas Coastal Islands Easy Sri Lanka Hotel Reservation Economic And Strategic Orientation Exotic Tastes of Sri Lanka Gramps and Life at 300 Hawaii How to Get To And Get Around Hawaii Ocean Kayak Tours Hospitable Sri Lanka Hotels How Americas Foreign Policy Indian Foreign Policy An Overview Indias Foreign Policy Predicament Interesting Facts About the Atlantic Islomania An Evolutionary Basis for Our Attraction Its Official Yuvraj is a Test Look East Policy Could Be the Kohinoor Making Your Trips to Sri Lanka Mission Vacation Beach Resort in Sri Lanka Nicknames of the Hawaiian Islands Ocean City on a Budget Ocean Facts Marine Life Oceans Reach Resort Ushers in Green Simple Luxuries at Boutique Hotels in Sri Lanka South Pacific Island in the Caribbean Sri Lanka The Pearl Sri Lanka Cultural Holiday Festivals Sri Lanka Festivals For Travelers Sri Lanka Holidays Excellent Tourist Sri Lanka Vacations The Top Reasons Sri Lankas Best Beaches The Best Reasons to Visit The Best Sri Lanka The Magical Whitsundays Activities and Island The Power of Ocean Paintings Top 10 Island Locations to Get Married Top 5 Attractions in Sri Lanka Travel Insurance From TATA AIG Travel Paradise Tiny Beautiful Traveling Tips Getting to Places and Hotels Unforgettable Vacations and Sri Lanka Visit Thailand Visit Similan Islands Wedding Spots in Ocean City Maryland What to Expect During