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结节病与结核病的灰色地带：一个诊断难题。

The Gray Area of Sarcoidosis and Tuberculosis: A Diagnostic Enigma.

作者信息

Meshram Shailesh B, Gandhi Rhea P, Reddy Geedhara Harsha Vardhan

机构信息

Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.

出版信息

Cureus. 2024 Oct 18;16(10):e71763. doi: 10.7759/cureus.71763. eCollection 2024 Oct.

DOI:10.7759/cureus.71763
PMID:39553098
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11569424/
Abstract

This case report presents a challenging diagnostic enigma, where a 29-year-old male patient presented with symptoms and signs favoring both tuberculosis (TB) and sarcoidosis. The patient's plain chest radiograph showed bilateral hilar opacities, while a contrast-enhanced computed tomography (CECT) scan revealed multiple mediastinal and hilar lymph nodes. Histopathology of a mediastinal lymph node biopsy showed necrotizing granulomatous inflammation, favoring TB. However, the patient's symptoms did not resolve with antitubercular treatment, and further investigations revealed a working diagnosis of pulmonary sarcoidosis. The patient's symptoms improved with corticosteroid therapy, and subsequent plain chest radiographs and high-resolution computed tomography (HRCT) scans showed near complete resolution of lung infiltrates. This case highlights the importance of careful evaluation and interpretation of biopsy results and the use of advanced diagnostic techniques to diagnose and differentiate between TB and sarcoidosis accurately.

摘要

本病例报告呈现了一个具有挑战性的诊断难题，一名29岁男性患者出现的症状和体征既支持肺结核（TB）又支持结节病。患者的胸部X线平片显示双侧肺门模糊，而增强计算机断层扫描（CECT）显示多个纵隔和肺门淋巴结。纵隔淋巴结活检的组织病理学显示坏死性肉芽肿性炎症，倾向于肺结核。然而，患者接受抗结核治疗后症状并未缓解，进一步检查显示最终诊断为肺结节病。患者接受皮质类固醇治疗后症状改善，随后的胸部X线平片和高分辨率计算机断层扫描（HRCT）显示肺部浸润几乎完全消退。本病例强调了仔细评估和解读活检结果以及使用先进诊断技术准确诊断和鉴别肺结核与结节病的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/65c291ab3de0/cureus-0016-00000071763-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/a676527a208f/cureus-0016-00000071763-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/b5cb0738dd30/cureus-0016-00000071763-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/f8f2b308fec8/cureus-0016-00000071763-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/b39ad2627b0b/cureus-0016-00000071763-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/9b861e362e08/cureus-0016-00000071763-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/f16d2fa406e5/cureus-0016-00000071763-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/b3e313cd4c42/cureus-0016-00000071763-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/65c291ab3de0/cureus-0016-00000071763-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/a676527a208f/cureus-0016-00000071763-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/b5cb0738dd30/cureus-0016-00000071763-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/f8f2b308fec8/cureus-0016-00000071763-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/b39ad2627b0b/cureus-0016-00000071763-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/9b861e362e08/cureus-0016-00000071763-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/f16d2fa406e5/cureus-0016-00000071763-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/b3e313cd4c42/cureus-0016-00000071763-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d258/11569424/65c291ab3de0/cureus-0016-00000071763-i08.jpg

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