PO41 - Not All Granulomas Are Sarcoidosis: Vertebral Tuberculosis Mimicking Disease Progression
Sofia Basílio Quaresma (Portugal)1; Mariana Godinho (Portugal)1; Gabriela Santos (Portugal)1; Carlos Araújo (Portugal)1; Inês Estalagem (Portugal)1; Inês Oliveira (Portugal)1; Miguel Lopes (Portugal)1;
1 - Hospital Garcia de Orta;
Keywords: Sarcoidosis; Vertebral tuberculosis; Granulomatous disease;
Select the theme: Challenges in Sarcoidosis Diagnosis and Staging
Type: Clinical Cases
Presentation: Poster Presentation

Introduction: Sarcoidosis is a multisystemic granulomatous disease that may rarely have bone involvement. Vertebral lesions can mimic infectious conditions, particularly tuberculosis (TB), creating a significant diagnostic challenge. This distinction is especially critical in patients from endemic regions, where overlapping clinical, radiological, and histopathological features may lead to misdiagnosis and delayed treatment.

Clinical Case Description: A 25-year-old male from Angola, with a previous hospitalization for multisystemic sarcoidosis, after discontinuing immunosuppressive therapy due to misunderstanding medical instructions, presented with dorsal pain and progressive paraparesis. Imaging revealed a D6–D7 vertebral lesion with epidural extension and spinal cord compression. Corticosteroid therapy resulted in transient neurological improvement. However, subsequent deterioration required urgent surgical decompression and stabilization.

Histopathology demonstrated necrotizing granulomatous inflammation, raising suspicion of tuberculosis despite the prior diagnosis of sarcoidosis. Considering epidemiological risk factors, history of TB contact and histological findings, empirical anti-tuberculous therapy was initiated despite negative initial PCR and microbiological studies.

Mycobacterium tuberculosis was later isolated in a dorsal abscess culture, confirming vertebral TB. Treatment was adjusted according to drug susceptibility testing, with favorable clinical evolution. Persistent neurological deficits were attributed to prior spinal cord injury, with partial improvement following rehabilitation.

Conclusions: This case illustrates a diagnostic dilemma in granulomatous vertebral disease, where tuberculosis may initially mimic sarcoidosis or disease progression. Necrotizing granulomas and epidemiological context should raise suspicion of TB, even when initial investigations are negative. Early recognition and multidisciplinary management are essential to improve outcomes and prevent irreversible neurological damage.