{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T15:52:51Z","timestamp":1785167571549,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by the formation of non-caseating granulomas in affected tissues and organs. In over half of the cases, the disease undergoes spontaneous remission. In contrast, tuberculosis (TB) is an infectious disease caused by <jats:italic>Mycobacterium tuberculosis<\/jats:italic>, which, if left untreated, can be fatal. Sarcoidosis and tuberculosis exhibit numerous overlapping clinical, radiological, and histopathological features, including the presence of epithelioid cell granulomas with multinucleated giant cells. Historically, a potential etiological role of <jats:italic>M. tuberculosis<\/jats:italic> in sarcoidosis has been proposed; however, this hypothesis has not been conclusively supported by current evidence or therapeutic outcomes. Differentiating between these two entities presents a significant diagnostic challenge, particularly in regions with a high prevalence of tuberculosis. The diagnostic complexity is further heightened in cases where a concomitant occurrence of both conditions is suspected. In such scenarios, the absence of a definitive biomarker hampers the ability to discern whether the diseases coexist independently or share a pathogenic link. This article reviews current evidence on the association between sarcoidosis and tuberculosis and explores potential pathways to elucidate their etiological interrelationship.<\/jats:p>","DOI":"10.3389\/fmed.2025.1602370","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:25:50Z","timestamp":1756099550000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case Report: Sarcoidosis or tuberculosis? A continuous challenge"],"prefix":"10.3389","volume":"12","author":[{"given":"Irina Ruxandra","family":"Strambu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Beer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1700991","DOI":"10.1183\/13993003.00991-2017","article-title":"Phenotypes of organ involvement in sarcoidosis","volume":"51","author":"Schupp","year":"2018","journal-title":"Eur Respir J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/S0272-5231(05)70416-0","article-title":"Pathology of sarcoidosis","volume":"18","author":"Sheffield","year":"1997","journal-title":"Clin Chest Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1136\/thoraxjnl-2019-214348","article-title":"BTS clinical statement on pulmonary sarcoidosis","volume":"76","author":"Thillai","year":"2021","journal-title":"Thorax"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"200","DOI":"10.36141\/svdld.v34i2.5674","article-title":"Mnemonic for the differential diagnosis of non-caseating granulomas","volume":"34","author":"Mehta","year":"2017","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e0154716","DOI":"10.1371\/journal.pone.0154716","article-title":"Immunological evidence for the role of mycobacteria in sarcoidosis: a meta-analysis","volume":"11","author":"Fang","year":"2016","journal-title":"PLoS One"},{"key":"ref6","first-page":"381","article-title":"Challenges in diagnosing sarcoidosis in tuberculosis endemic regions: clinical scenario in India","volume":"33","author":"Guleria","year":"2016","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"ref7","first-page":"661s","article-title":"Sarcoidosis and tuberculosis: a rare combination?","volume":"40","author":"Calaras","year":"2012","journal-title":"Eur Respir J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.2147\/TCRM.S95805","article-title":"Systemic spread of tuberculosis after surgery for a splenic tuberculous abscess without postoperational antituberculosis treatment: a case report","volume":"11","author":"Yan","year":"2015","journal-title":"Ther Clin Risk Manag"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1186\/1757-1626-1-383","article-title":"Disseminated tuberculosis following the placement of ureteral stents: a case repot","volume":"1","author":"Salem","year":"2008","journal-title":"Cases J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3591","DOI":"10.1136\/bcr.12.2010.3591","article-title":"Disseminated (miliary) abdominal tuberculosis after laparoscopic gastric bypass surgery","volume":"2011","author":"Alhajri","year":"2011","journal-title":"Case Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1183\/09031936.03.00051603","article-title":"Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions","volume":"220","author":"Jim\u00e9nez Castro","year":"2003","journal-title":"Eur Respir J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.tube.2016.01.003","article-title":"Tuberculosis or sarcoidosis: opposite ends of the same disease spectrum?","volume":"98","author":"Agrawal","year":"2016","journal-title":"Tuberculosis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"51","DOI":"10.4103\/lungindia.lungindia_960_20","article-title":"Clinical profile of 327 patients with sarcoidosis in India: an ambispective cohort study in a tuberculosis endemic population","volume":"39","author":"Madan","year":"2022","journal-title":"Lung India"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.3389\/fimmu.2020.01340","article-title":"Environmental risk factors for sarcoidosis","volume":"11","author":"Judson","year":"2020","journal-title":"Front Immunol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3755","DOI":"10.21037\/qims-23-1696","article-title":"Coexistence of tuberculosis and sarcoidosis: a description of two cases","volume":"14","author":"Dai","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e11662","DOI":"10.7759\/cureus.11662","article-title":"Tuberculosis and sarcoidosis overlap: a clinical challenge from diagnosis to treatment","volume":"12","author":"Pedroso","year":"2020","journal-title":"Cureus"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/j.ad.2016.02.009","article-title":"Sarcoidosis y tuberculosis: un desaf\u00edo diagn\u00f3stico","volume":"107","author":"de la Fuente-Meira","year":"2016","journal-title":"Actas Dermosifiliogr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1183\/09031936.00002607","article-title":"Molecular evidence for the role of mycobacteria in sarcoidosis: a meta-analysis","volume":"30","author":"Gupta","year":"2007","journal-title":"Eur Respir J"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"PA5202","DOI":"10.1183\/13993003.congress-2018.PA5202","article-title":"Microbiological study of mediastinal lymph node biopsy from patients with sarcoidosis and lung cancer","volume":"52","author":"Durakovic","year":"2018","journal-title":"Eur Respir J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1111\/j.0954-6820.1964.tb05700.x","article-title":"Further studies of mycobacterial antibodies in the sera of sarcoidosis patients","volume":"176","author":"Chapman","year":"1964","journal-title":"Acta Med Scand"},{"key":"ref21","first-page":"25","article-title":"Prolonged culture for mycobacteria in mediastinal lymph nodes from patients with pulmonary sarcoidosis. A negative study","volume":"21","author":"Milman","year":"2004","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1136\/bmj.2.5213.1617","article-title":"Mycobacterium tuberculosis in the etiology of sarcoidosis","volume":"2","author":"Scadding","year":"1960","journal-title":"BMJ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1902","DOI":"10.1016\/j.chest.2020.10.023","article-title":"Phase II investigation of the efficacy of antimycobacterial therapy in chronic pulmonary sarcoidosis","volume":"159","author":"Wonder","year":"2021","journal-title":"Chest"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.3390\/microorganisms8081212","article-title":"Systematic assessment of Mycobacterium avium subspecies paratuberculosis infections from 1911-2019: a growth analysis of association with human autoimmune diseases","volume":"8","author":"Ekundayo","year":"2020","journal-title":"Microorganisms"},{"key":"ref25","first-page":"32","article-title":"Serologic reactivity against Mycobacterium paratuberculosis antigens in patients with sarcoidosis","volume":"10","author":"Reid","year":"1993","journal-title":"Sarcoidosis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"829","DOI":"10.3390\/microorganisms11040829","article-title":"Sarcoidosis, mycobacterium paratuberculosis and noncaseating granulomas: who moved my cheese?","volume":"11","author":"Dow","year":"2023","journal-title":"Microorganisms"},{"key":"ref27","author":"Macovei","year":"2013"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.1016\/j.reuma.2017.07.022","article-title":"Pulmonary sarcoidosis mimicking tuberculosis: importance of the galaxy sign on thoracic computed tomography","volume":"15","author":"Saras\u00faa","year":"2019","journal-title":"Reumatol Clin"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"579","DOI":"10.7754\/Clin.Lab.2023.230823","article-title":"A case of tuberculosis misdiagnosed as sarcoidosis and then confirmed by NGS testing","volume":"70","author":"Yang","year":"2024","journal-title":"Clin Lab"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"5760","DOI":"10.21037\/jtd-23-192","article-title":"Diagnosis of pulmonary sarcoidosis in tuberculosis endemic area\u2014a narrative review","volume":"15","author":"Sodsri","year":"2023","journal-title":"J Thorac Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1097\/MCP.0b013e3283560809","article-title":"Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders","volume":"18","author":"Gupta","year":"2012","journal-title":"Curr Opin Pulm Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/1471-2334-11-96","article-title":"The clinical utility of tuberculin skin test and interferon-\u03b3 release assay in the diagnosis of active tuberculosis among young adults: a prospective observational study","volume":"11","author":"Lee","year":"2011","journal-title":"BMC Infect Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.ebiom.2016.04.024","article-title":"Diagnostic performance of bronchoalveolar lavage fluid CD4\/CD8 ratio for sarcoidosis: a meta-analysis","volume":"8","author":"Shen","year":"2016","journal-title":"EBioMedicine"},{"key":"ref34","first-page":"185","article-title":"The CD4+\/CD8+ ratio in pulmonary tuberculosis: systematic and meta-analysis article","volume":"44","author":"Yin","year":"2015","journal-title":"Iran J Public Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.2967\/jnumed.112.104380","article-title":"The utility of 18F-FDG PET\/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis","volume":"53","author":"Sobic-Saranovic","year":"2012","journal-title":"J Nucl Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e70630","DOI":"10.1371\/journal.pone.0070630","article-title":"Transcriptional blood signatures distinguish pulmonary tuberculosis, pulmonary sarcoidosis, pneumonias and lung cancers","volume":"8","author":"Bloom","year":"2013","journal-title":"PLoS One"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1513\/AnnalsATS.202206-529OC","article-title":"Validation of the sarcoidosis diagnostic score in a multicontinental study","volume":"20","author":"Jeny","year":"2023","journal-title":"Ann Am Thorac Soc"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"101127","DOI":"10.1016\/j.resmer.2024.101127","article-title":"Sarcoidosis diagnostic score (SDS) system: impact of race, sex, organ involvement and duration of symptoms prior to diagnosis","volume":"86","author":"Zhou","year":"2024","journal-title":"Respir Med Res"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1602370\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:25:52Z","timestamp":1756099552000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1602370\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":38,"alternative-id":["10.3389\/fmed.2025.1602370"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1602370","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"article-number":"1602370"}}