Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.
Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
J Int Med Res. 2021 Apr;49(4):3000605211001632. doi: 10.1177/03000605211001632.
The coexistence of pulmonary tuberculosis and pulmonary sarcoidosis is rare. Further, the morphological features of pulmonary tuberculosis with comorbid pulmonary sarcoidosis are similar to those of tuberculosis alone. There are obvious clinical, histological, and radiological similarities between sarcoidosis and tuberculosis, which makes differential diagnosis very challenging, particularly in countries with a high burden of tuberculosis. Here, a rare case of computed tomography (CT) findings of sarcoidosis that developed during tuberculosis treatment is reported. The 46-year-old male patient had no significant symptoms and was undergoing treatment for infection. Chest CT revealed enlargement of multiple lymph nodes, without cystic or necrotic changes, in the mediastinum and both hili, and post-infectious changes consistent with the sequelae of tuberculosis infection in the left upper lobe. Chest radiographic evidence was accompanied by compatible clinical features and noncaseating granulomas on biopsy. As the patient was clinically stable, corticosteroid treatment was not initiated. To date, the patient remains without specific symptoms and outpatient follow-ups continue. Although rare, sarcoidosis may occur during treatment of pulmonary tuberculosis, and requires attention for diagnosis and treatment. The present case draws a radiological picture of how tuberculosis evolved to sarcoidosis.
肺结核和肺结节病并存较为罕见。此外，合并肺结节病的肺结核的形态学特征与单纯肺结核相似。结节病和肺结核在临床表现、组织学和影像学方面有明显的相似之处，这使得鉴别诊断极具挑战，尤其是在结核病负担较高的国家。本文报道了一例在肺结核治疗过程中发生的结节病的罕见 CT 表现。该例 46 岁男性患者无症状，正在接受治疗。胸部 CT 显示纵隔和双侧肺门多个淋巴结肿大，无囊状或坏死改变，左肺上叶有符合结核感染后遗症的感染后改变。胸部 X 线表现伴有相符的临床特征和活检的非干酪样肉芽肿。由于患者临床稳定，未开始皮质类固醇治疗。迄今为止，患者无症状，仍在门诊随访中。尽管罕见，但肺结核治疗过程中可能会发生结节病，需要注意诊断和治疗。本病例描绘了肺结核向结节病演变的影像学特征。
