A long-term tuberculosis process with a drug-resistant pathogen under the guise of lung sarcoidosis

Sarcoidosis and pulmonary tuberculosis are the most common granulomatous diseases affecting lung tissue. At the same time, these nosologies have completely different treatment methods, which requires timely and correct assessment of the patient's condition and the establishment of a correct diagnosis. A practical observation is given showing the long-term course of the tuberculous process under the guise of pulmonary sarcoidosis. Patient C, 37 years old, has not had contact with tuberculosis patients. Changes in the lungs were detected in 2020, due to which further investigation and ruling out of the diagnosis of tuberculosis. Fibrobronchoscopy with the MBT complex did not detect any mycobacteria. The cytological picture was regarded as granulomatous inflammation without specificity. In this case, the patient was diagnosed with sarcoid of the lungs in an active phase.Metipred 32 mg per day for one year was prescribed.. Since November 2021, he noted deterioration in his condition and a negative trend, in the form of increased focal infiltrative changes on both lungs on CT on 10/06/22. During bronchoscopy, MBT DNA was detected and MBT growth in the crop was detected. Applied to the FGBI "CTRI" where resistance to HR was established and appropriate TB therapy was implemented. After 4 months of treatment positive clinical and radiological changes were noted.