The clinical labyrinth of chronic granulomatous diseases: not only sarcoidosis

Case Description: Sarcoidosis and tuberculosis are two pathologies that in some cases share similar clinical features. In other cases the differential diagnosis appears more difficult, as these two pathologies can coexist or even mimic each other. Our diagnostic challenge began in November 2020, when a 22-year-old male patient with suspected sarcoidosis came to our observation, suffering from dysphonia and dry cough since 2019. The patient in 2016 presented a contact with a tuberculosis positive case in school environment, therefore at that time he began a prophylactic treatment with isoniazid, suspended after 3 weeks due to an increase in cholestasis indices. He had also previously undergone a laryngeal mass reduction surgery, whose histological examination described a picture of granulomatous laryngitis with sarcoid-like features with Ziehl-Neelsen staining negative. Clinical Hypothesis: We ruled out autoimmune, neoplastic and infectious diseases. Diagnostic Pathways: Then quantiferon TB-Gold test was positive such as the mycobacterium-oriented sputum culture examination. So we formulated the diagnosis of isolated laryngeal tuberculosis. Subsequently the patient undertook the specific antitubecular therapy with a remarkable clinical-instrumental improvement, associated with the regression of the laryngeal lesion, reaching at the end of the therapy itself the complete healing. Discussion and Learning Points: This case suggests how deep the attention must be on the granulomatous diseases, which can coexist and even exclude each other, but at the same time can share some features. The chosen diagnostic arsenal is profoundly decisive for a correct clinical and therapeutic setting.