Sarcoidosis, tuberculosis, and the clinical dilemma of treating granulomatous inflammation

Sarcoidosis can have a varied presentation, including an overlap with tuberculosis (TB). It can precede or coexist with TB. Certain features such as cavitary consolidation, pleural effusion, and tree-in-bud nodules are highly suggestive of active TB. The perilymphatic distribution of micronodules and discrete lymph nodes are features suggestive of sarcoidosis. Identifying the coexistence of the diseases is essential, as the treatment of either disease is a paradox: immunosuppression in sarcoidosis and antitubercular therapy in TB. There are certain conditions in which immunosuppression is used in TB, e.g., tubercular meningitis, ocular TB, and TB pericarditis. This article aims to provide a better understanding of the clinical dilemma faced during the treatment of granulomatous inflammation and adds to the existing literature regarding the overlap between sarcoidosis and TB.