Mise Kornelija, Goic-Barisic Ivana, Puizina-Ivic Neira, Barisic Igor, Tonkic Marija, Peric Irena
Department of Clinical Microbiology and School of Medicine University of Split, Split, Croatia.
Cases J. 2010 Jan 13;3:24. doi: 10.1186/1757-1626-3-24.
Tuberculosis and sarcoidosis are chronic diseases that rarely occur concomitantly. Sarcoidosis is a multisystem granulomatous disorder characterized pathologically by the presence of non-caseating granulomas in involved tissues. Tuberculosis is infectious disease caused by Mycobacterium tuberculosis characterized by granulomas with caseous necrosis.
We present a case of 43-year-old female refugee from Kosovo with microbiological confirmation of pulmonary tuberculosis and pulmonary and skin sarcoidosis at the same time. Three weeks after corticosteroid therapy for pulmonary sarcoidosis was introduced, positive finding of mycobacterium culture of bronchial aspirate was observed. Based on these results, corticosteroid therapy was excluded and antituberculous therapy was introduced for six months. In the meantime, new nodes on face and nose appeared and skin sarcoidosis was diagnosed. The patient was given corticosteroids and colchicine according to the skin and pulmonary sarcoidosis therapy recommendation.
The authors of this study suggest that in cases when there is a dilemma in diagnosis between tuberculosis and sarcoidosis we should advance with corticosteroid therapy until we have microbiological confirmation of mycobacterium culture. This case is remarkable because this is a third described case of sarcoidosis and tuberculosis together (the first reported in Asia, the second in South Africa), and to authors knowledge, this is a first case report in Europe.
结核病和结节病是很少同时发生的慢性疾病。结节病是一种多系统肉芽肿性疾病，其病理特征是受累组织中存在非干酪样肉芽肿。结核病是由结核分枝杆菌引起的传染病，其特征是肉芽肿伴有干酪样坏死。
我们报告一例43岁来自科索沃的女性难民，经微生物学证实同时患有肺结核以及肺部和皮肤结节病。在开始针对肺部结节病的皮质类固醇治疗三周后，观察到支气管吸出物的分枝杆菌培养呈阳性结果。基于这些结果，停用皮质类固醇治疗并开始进行为期六个月的抗结核治疗。与此同时，面部和鼻部出现新的结节，诊断为皮肤结节病。根据皮肤和肺部结节病的治疗建议，给予患者皮质类固醇和秋水仙碱治疗。
本研究的作者建议，在结核病和结节病诊断存在两难情况时，我们应先进行皮质类固醇治疗，直至获得分枝杆菌培养的微生物学证实。该病例值得关注，因为这是第三例同时患有结节病和结核病的病例（第一例在亚洲报道，第二例在南非），据作者所知，这是欧洲的首例病例报告。
