Contribution to differential diagnosis of sarcoidosis and disseminated tuberculosis.

A previously healthy 54-year-old ethnically Danish man was referred to the Department of Infectious Diseases at Aarhus University Hospital after an unexpected detection of Mycobacterium tuberculosis DNA in his lungs. Further examination revealed widespread dissemination of the tuberculosis (TB) to brain, mastoid, urinary and gastrointestinal tract. Thirteen months earlier, the patient was orchiectomised due to recurring inflammation of the right testicle. Three and a half months prior to admission to our department the patient started immunosuppressive therapy with steroids due to radiological and histological findings in the lungs that were interpreted as sarcoidosis (SA). This treatment is likely to be co-responsible for the pronounced dissemination of the TB. The patient was Bacillus Calmette-Guérin (BCG)-vaccinated as a child and had no apparent risk factors for TB apart from travelling in TB-endemic countries until 10 years before falling ill. Screening for latent TB was not performed prior to starting steroid treatment.