Posters
Presenting Author Academic/Professional Position
Luis Salcedo
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Academic Level (Author 5)
Faculty
Discipline/Specialty (Author 5)
Internal Medicine
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Introduction: Pulmonary sarcoidosis can pose considerable diagnostic challenges, particularly in young adults hailing from regions endemic to tuberculosis (TB), wherein radiographic manifestations may closely mimic those of miliary TB. This case underscores the necessity of sustaining an extensive differential diagnosis and accentuates the critical role of histological verification in the assessment of diffuse pulmonary micronodular infiltrates, especially in instances where the infectious workup yields negative results.
Case Report: A 26-year-old male from the Democratic Republic of Congo, with no significant medical history, presented with a 10–12 month history of chronic dry cough and exertional dyspnea. He denied fever, weight loss, night sweats, or hemoptysis. He was a lifelong non-smoker with no occupational exposures. A positive PPD test from 2020 had not been followed up.
Chest radiography and high-resolution CT revealed diffuse bilateral micronodular infiltrates consistent with a miliary pattern. Given his background and radiologic findings, miliary TB was initially suspected. However, sputum AFB smears, cultures, bronchoalveolar lavage, and serologic testing for HIV, fungi, and autoimmune markers were all negative.
Laboratory findings revealed elevated ACE (103 U/L) and CRP (30 mg/L). Bronchoscopy with transbronchial biopsy showed non-caseating granulomas with fibrin deposition. Stains for AFB and fungi were negative, and no malignancy was found. Based on the radiologic, histologic, and clinical findings, a diagnosis of pulmonary sarcoidosis was made.
The patient was started on oral prednisone (20 mg/day). After one month, he reported marked improvement in symptoms, and follow-up HRCT showed near-complete resolution of nodules. ACE levels normalized, and no adverse effects from corticosteroids were noted.
Discussion: This case elucidates the diagnostic ambiguity that exists between pulmonary sarcoidosis and miliary tuberculosis (TB), especially in individuals originating from regions where TB is endemic. Though miliary TB is frequently presumed in the presence of diffuse micronodular radiologic patterns, the lack of systemic symptoms coupled with consistently negative microbiological outcomes should incite the exploration of alternative diagnoses, such as sarcoidosis.
Sarcoidosis represents a complex granulomatous condition of indeterminate etiology, predominantly involving the pulmonary system. The diagnostic process is contingent upon clinical suspicion, radiological assessments, and histopathological verification of non-caseating granulomas. While elevated angiotensin-converting enzyme (ACE) levels may lend support to the diagnosis, it is imperative to recognize that they lack specificity.
Corticosteroids continue to be the primary therapeutic intervention for symptomatic pulmonary sarcoidosis, often resulting in prompt clinical and radiological enhancement, as evidenced in this case. Nevertheless, the long-term prognosis is variable, with relapse rates potentially reaching 75%, thus necessitating extended follow-up. In instances where patients exhibit a lack of responsiveness to steroid therapy, immunosuppressive agents such as methotrexate or tumor necrosis factor-alpha (TNF-α) inhibitors may become essential.
This case further emphasizes the critical nature of interdisciplinary collaboration among pulmonology, infectious disease, and pathology specialists to facilitate the timely and precise diagnosis of atypical pulmonary manifestations.
Conclusion: In young adults with diffuse pulmonary nodules, especially when imaging mimics miliary TB, sarcoidosis should be considered if infectious workup is negative. Histologic confirmation is essential for diagnosis. Early corticosteroid therapy can lead to rapid improvement, but close monitoring is vital due to the risk of relapse and progression.
Presentation Type
Poster
Recommended Citation
Calderon, Aura M. C.; Salcedo, Luis; Mogollon, Ivan; Arias, Francisco; and Gomez, Juan Pablo, "Progressive Pulmonary Sarcoidosis in a Young Adult Mimicking Miliary Tuberculosis: A Case Report and Literature Review" (2025). Research Colloquium. 19.
https://scholarworks.utrgv.edu/colloquium/2025/posters/19
Included in
Progressive Pulmonary Sarcoidosis in a Young Adult Mimicking Miliary Tuberculosis: A Case Report and Literature Review
Introduction: Pulmonary sarcoidosis can pose considerable diagnostic challenges, particularly in young adults hailing from regions endemic to tuberculosis (TB), wherein radiographic manifestations may closely mimic those of miliary TB. This case underscores the necessity of sustaining an extensive differential diagnosis and accentuates the critical role of histological verification in the assessment of diffuse pulmonary micronodular infiltrates, especially in instances where the infectious workup yields negative results.
Case Report: A 26-year-old male from the Democratic Republic of Congo, with no significant medical history, presented with a 10–12 month history of chronic dry cough and exertional dyspnea. He denied fever, weight loss, night sweats, or hemoptysis. He was a lifelong non-smoker with no occupational exposures. A positive PPD test from 2020 had not been followed up.
Chest radiography and high-resolution CT revealed diffuse bilateral micronodular infiltrates consistent with a miliary pattern. Given his background and radiologic findings, miliary TB was initially suspected. However, sputum AFB smears, cultures, bronchoalveolar lavage, and serologic testing for HIV, fungi, and autoimmune markers were all negative.
Laboratory findings revealed elevated ACE (103 U/L) and CRP (30 mg/L). Bronchoscopy with transbronchial biopsy showed non-caseating granulomas with fibrin deposition. Stains for AFB and fungi were negative, and no malignancy was found. Based on the radiologic, histologic, and clinical findings, a diagnosis of pulmonary sarcoidosis was made.
The patient was started on oral prednisone (20 mg/day). After one month, he reported marked improvement in symptoms, and follow-up HRCT showed near-complete resolution of nodules. ACE levels normalized, and no adverse effects from corticosteroids were noted.
Discussion: This case elucidates the diagnostic ambiguity that exists between pulmonary sarcoidosis and miliary tuberculosis (TB), especially in individuals originating from regions where TB is endemic. Though miliary TB is frequently presumed in the presence of diffuse micronodular radiologic patterns, the lack of systemic symptoms coupled with consistently negative microbiological outcomes should incite the exploration of alternative diagnoses, such as sarcoidosis.
Sarcoidosis represents a complex granulomatous condition of indeterminate etiology, predominantly involving the pulmonary system. The diagnostic process is contingent upon clinical suspicion, radiological assessments, and histopathological verification of non-caseating granulomas. While elevated angiotensin-converting enzyme (ACE) levels may lend support to the diagnosis, it is imperative to recognize that they lack specificity.
Corticosteroids continue to be the primary therapeutic intervention for symptomatic pulmonary sarcoidosis, often resulting in prompt clinical and radiological enhancement, as evidenced in this case. Nevertheless, the long-term prognosis is variable, with relapse rates potentially reaching 75%, thus necessitating extended follow-up. In instances where patients exhibit a lack of responsiveness to steroid therapy, immunosuppressive agents such as methotrexate or tumor necrosis factor-alpha (TNF-α) inhibitors may become essential.
This case further emphasizes the critical nature of interdisciplinary collaboration among pulmonology, infectious disease, and pathology specialists to facilitate the timely and precise diagnosis of atypical pulmonary manifestations.
Conclusion: In young adults with diffuse pulmonary nodules, especially when imaging mimics miliary TB, sarcoidosis should be considered if infectious workup is negative. Histologic confirmation is essential for diagnosis. Early corticosteroid therapy can lead to rapid improvement, but close monitoring is vital due to the risk of relapse and progression.
