Not All that Granulomas is Tuberculosis: Sarcoidosis Masquerading as Tuberculosis

Sarcoidosis is a systemic inflammatory disease characterized by noncaseating granulomas, primarily affecting young adults and often involving the lungs, skin, and other organs. This case report discusses a 46-year-old female presenting with breathlessness, chronic cough, and joint pains, initially raising suspicion for tuberculosis (TB) due to overlapping clinical features. Diagnostic imaging revealed bilateral hilar lymphadenopathy, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the presence of noncaseating granulomas, leading to a diagnosis of pulmonary sarcoidosis. The patient was treated with corticosteroids, resulting in significant clinical improvement. This case highlights the diagnostic challenges in TB-endemic regions, where sarcoidosis can masquerade as TB due to similar presentations. The importance of distinguishing between these two conditions is underscored, as misdiagnosis can lead to inappropriate treatment. In India, where TB is prevalent, awareness and advanced diagnostic techniques are crucial for the accurate identification of sarcoidosis. The report emphasizes the need for further research and national registries to better understand the epidemiology and management of sarcoidosis in such settings.