Tuberculosis - sarcoidosis, a challenge diagnosis: case report

Introduction: Tuberculosis (TBC) and sarcoidosis have many similarities in their clinical manifestation, radiology and histology. The concept tuberculosis-sarcoidosis, refers to a clinical entity with different kinds of presentations, where TBC may precede, follow or coexist with the course of Sarcoidosis. Case report: 47 year old woman with a history of myomectomy and cholecystectomy, with a history of 4 months of difuse crampy abdominal pain, with hyporexia and 15 kilogram weight loss. Worsening of the pain made her go to the emergency unit, also presented frontal intense headache. In that moment she is admitted in the hospital to be studied for specialists. The symptoms evolved the next day with peripheral right facial paresis, left trigeminal commitment V1-V2, left abdominal hypoesthesia T10 to L1, swallowing symptoms of left lateral cutaneous nerve gloso. It was decided to continue study with lumbar puncture informing: protein: 0.81 mg / dl, glucose 62 mg / dl, 100% mono-nuclear Ziehl Nielsen and Gram negative. Chest CT identified mediastinal lymph nodes. In their biopsy, cheesy foci of necrosis, Ziehl Nielsen (+) was reported. She started corticoidaland antituberculosis treatment but she evolved in poor conditions; adding neuropathic costal pain and bilateral uveitis, so methotrexate (MTX) was added. Because of the none responding symptoms and dealing with a corticoid- and resistent disease it was decided to start with Infliximab, with great clinical response. Discussion: These entities can be confused with several neurological, muscle, or vascular conditions, it requires a multidisciplinary approach early, although generally, the classic response to treatment is low.