Necrotizing Sarcoid Granulomatosis in Endemic Area of Mycobacterial Tuberculosis Infection: A Case Report

Abstract

A 35-year-old man from Azerbaijan presented with chronic cough, exertional dyspnea, significant weight loss and skin papules. His skin biopsy revealed non-necrotizing granuloma with negative acid fast bacilli stain. He was prescribed anti tuberculous drugs for 3 months without improvement.  His chest X-ray showed diffuse reticulonodular infiltrations and prominent hilar shadows. Perilymphatic nodules, right paratracheal and both hilar lymphadenopathies were demonstrated on high resolution computer tomography (HRCT) scan. There was no evidence of tuberculosis from bronchoalveolar lavage fluid and lung tissue. Histopathology from lung biopsy showed necrotizing granuloma with high CD4/CD8 ratio.  Since his symptoms did not improve after anti tuberculous drugs and HRCT patterns were compatible with sarcoidosis, steroid was initiated. After 13 months of steroid treatment, he had no symptoms and follow-up HRCT showed no infiltration or lymphadenopathy. In conclusion, his diagnosis was necrotizing sarcoid granulomatosis with lung and skin involvement.