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Despite the suspicion of sarcoidosis, a trial of antituberculosis therapy was started empirically due to similar presentations of disseminated tuberculosis (TB) in this high endemic area. The patient subsequently deteriorated and was admitted with symptomatic hypercalcaemia. Her subsequent ACE levels were very high, supportive of a diagnosis of systemic sarcoidosis. She was given steroid pulse therapy, and 5 months later had fully recovered. This case highlights the challenges faced by physicians in high TB-endemic areas when managing granulomatous diseases as they are concerned about missing TB, the difficulties in diagnosing sarcoidosis and the role of pulse steroid therapy.<\/jats:p>","DOI":"10.1136\/bcr-2016-218741","type":"journal-article","created":{"date-parts":[[2017,5,12]],"date-time":"2017-05-12T09:57:09Z","timestamp":1494583029000},"page":"bcr-2016-218741","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["The clinical conundrum of diagnosing and treating systemic sarcoidosis in a high TB burden area"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-8980","authenticated-orcid":false,"given":"Krishnadas","family":"Thulasidoss","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lavanya","family":"Asokan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piyush","family":"Chandra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pravinkumar","family":"Rejliwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,5,12]]},"reference":[{"key":"2025042706091434000_2017.may12_3.bcr-2016-218741.1","first-page":"256","article-title":"High-dose methylprednisolone pulse therapy in sarcoidosis","volume":"68(4","author":"Wallaert","year":"1986","journal-title":"Eur J Respir Dis"},{"key":"2025042706091434000_2017.may12_3.bcr-2016-218741.2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1445-5994.1985.tb02731.x","article-title":"Intravenous pulse methyl prednisolone in the successful treatment of severe sarcoid polyneuropathy with pulmonary involvement","volume":"15","author":"Allen","year":"1985","journal-title":"Aust N Z J Med"},{"key":"2025042706091434000_2017.may12_3.bcr-2016-218741.3","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/1869-5760-3-53","article-title":"Sarcoidosis in tuberculosis-endemic regions: india","volume":"3","author":"Babu","year":"2013","journal-title":"J Ophthalmic Inflamm Infect"},{"key":"2025042706091434000_2017.may12_3.bcr-2016-218741.4","unstructured":"WHO. 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