# The diagnosis dilemma of coexistence of neurosarcoidosis and tuberculosis: case reports and literature review

## TL;DR

This paper discusses the diagnostic challenges of neurosarcoidosis and tuberculosis coexisting, emphasizing the importance of thorough TB screening.

## Contribution

The paper presents three case reports highlighting the coexistence of neurosarcoidosis and tuberculosis, emphasizing the diagnostic challenges.

## Key findings

- Three patients with neurosarcoidosis also had tuberculosis, either active or latent.
- FDG PET is useful for detecting extraneural sarcoidosis and guiding biopsies.
- Thorough TB screening is crucial before treating sarcoidosis due to potential coexistence.

## Abstract

Sarcoidosis is a multisystem disease pathologically characterized by non-caseating epithelioid granulomas. Its neurological form, neurosarcoidosis (NS), can affect the central nervous system (CNS) and/or the peripheral nervous system (PNS), posing a significant diagnostic challenge. The diagnostic dilemma is further complicated by the significant clinicopathological overlap between sarcoidosis and tuberculosis (TB). Although rare, sarcoidosis and TB can coexist. Our case series included three NS patients: two had CNS involvement and one had PNS involvement. Notably, two patients had confirmed active tuberculosis infection and one patient had a latent TB infection. This highlights the diagnostic and therapeutic challenges of these coexisting conditions. Fluorodeoxyglucose positron emission computed tomography (FDG PET) helps detect extraneural sarcoidosis locations and find biopsy sites. Regarding the similarity and potential coexistence of TB and sarcoidosis, thorough screening for TB infection is essential before initiating any therapy for sarcoidosis.