Abstract
CLINICORADIOLOGICAL SPECTRUM OF SARCOIDOSIS PRESENTING TO A TERTIARY CARE CENTRE IN TUBERCULOSIS ENDEMIC AREA

Ashesh Dhungana* MD, DM and Randeep Guleria MD, DM.

ABSTRACT

Background: Sarcoidosis is a multisystem, inflammatory disorder in which lung and intrathoracic lymph node are commonly involved. In a patient with consistent clinico-radiological features, the diagnosis is established by histological or cytological demonstration of non-caseating epithelioid-cell granuloma in tissues. The true incidence of sarcoidosis is difficult to discern in tuberculosis endemic areas as both disease conditions have outstanding resemblance. In case of thoracic involvement flexible bronchoscopy remains the procedure of choice owing to good sensitivity and low complication rates. Material and Methods: This was a retrospective study done on 62 patients confirmed to have sarcoidosis based on clinic-radiological and bronchoscopy data. Clinical history, laboratory, spirometry and bronchoscopy data were extracted from medical records of the patients and analysed. Results: Out of the 62 patients, 48 (77%) had histological evidence of granuloma in one of the bronchoscopy samples. In the remaining 14 patients the diagnosis was confirmed after response to treatment at the end of 6 months. The distribution of study population was: Stage I - 24 (39%), Stage II - 31 (50%) and Stage III - 7 (11%) disease. Dry cough, dyspnoea, fever and weight loss were the most common symptoms. The mean serum ACE levels was 84 (±37) U/L. Mantoux test was negative (induration < 5 mm) in all patients. Spirometry revealed an abnormality in 18 (29%) patients. EBUS-TBNA had the highest diagnostic yield as it was positive in 26 out of 32 (81%) patients, followed by TBLB which was positive in 26 out of 44 (59%) patients. Conventional TBNA yielded the diagnosis in 9/24 (38%) and EBB in 9/37 (24%) patients. Conclusion: Sarcoidosis is common in tuberculosis endemic area and differentiation from tuberculosis is important for treatment purpose. EBUS has the highest yield in detection of granuloma from bronchoscopy samples followed by bronchoscopic lung biopsy.

Keywords: Sarcoidosis, transbronchial needle aspiration, endobronchial ultrasound, bronchoscopic lung biopsy.


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