Case report

Sarcoidosis or miliary tuberculosis – a case report

Ana Vujaklija Brajković ; Zavod za intenzivnu medicinu, Klinika za unutarnje bolesti, KBC Zagreb, Zagreb, Hrvatska
Ivan Puljiz ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Ozrenka Zlopaša ; Zavod za intenzivnu medicinu, Klinika za unutarnje bolesti, KBC Zagreb, Zagreb, Hrvatska
Dubravka Bosnić ; Zavod za kliničku imunologiju i reumatologiju, Klinika za unutarnje bolesti, KBC Zagreb, Zagreb, Hrvatska
Vladimir Gašparović ; Zavod za intenzivnu medicinu, Klinika za unutarnje bolesti, KBC Zagreb, Zagreb, Hrvatska

Abstract

We present a previously healthly 59-year-old patient with fever, cough and liver disease. Liver biopsy showed non-necrotizing ("non-caseating") granulomas. The level of angiotensin-converting enzyme was above the reference range (85 U/L). Blood, urine and cerebrospinal fluid cultures were repeatedly sterile. No mycobacteria were detected in the sputum. Given the above findings, sarcoidosis was suspected and corticosteroid therapy was initiated. However, the patient was getting worse and developed acute kidney injury together with partial respiratory insufficiency. The chest CT showed interstitial infiltrate, mainly in the upper lobes of the lung, mediastinal lymph node enlargement with partial colliquation. Bronchoscopic aspiration and bronchoalveolar lavage was performed two times; no Mycobacterium was detected. Transbronchial needle aspiration also found no Mycobacterium. Ophthalmologic examination revealed choroiditis and antituberculosis therapy was initiated. Mycobacterium tuberculosis was later detected in culture of bone marrow. After five months of antituberculosis therapy the patient completely recovered, his liver tests were normal as well as renal function.

Keywords

Sarcoidosis; miliary tuberculosis; acute kidney injury; liver disease

Hrčak ID:

133427

URI

https://hrcak.srce.hr/133427

Publication date:

30.6.2013.

Article data in other languages: croatian

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