This inflammatory disease is often misdiagnosed as tuberculosis because of its common symptoms
Sarcoidosis, an inflammatory disease, is grossly underdiagnosed in India. The reason: it looks a lot like tuberculosis (TB), one of the deadliest infectious diseases here.
Of course, doctors take many things into account before they form a diagnosis. In India, TB is much more common than sarcoidosis, so doctors have a stronger reason to suspect TB in a patient with symptoms like a persistent dry cough, fever and wheezing.
“The trouble is that TB medication can have side-effects like acute liver failure. They pose an unnecessary risk and cost for sarcoidosis patients," explained Dr Ayush Pandey, a medical practitioner associated with myUpchar.com. "Usually, sarcoidosis resolves itself in a few years. In cases where a patient needs medication, a course of corticosteroids is often enough,” he added.
Given the significant government push to end TB in India by 2025, it is important to relook at sarcoidosis - a disease that looks so much like TB, but isn’t.
What is sarcoidosis?
Doctors don’t yet know what causes sarcoidosis. What they do know is that it is an inflammatory disease that is triggered by the body’s immune response. The disease often affects the lungs and the lymph nodes, but it can also impact the eyes, skin, heart and other organs. Patients typically develop tiny non-cancerous lumps called granuloma on their bodies.
The list of symptoms of sarcoidosis is long and varied. From fatigue, fever, swollen lymph nodes to dry cough, shortness of breath, rashes, sores or lesions on nose or cheeks, dry eyes and arrhythmia (irregular heartbeat), sarcoidosis can have different symptoms depending on which part of the body it affects.
Sarcoidosis in India
“The true burden of sarcoidosis in India is not clearly known as reliable epidemiological data are not available,” Professor S.K. Sharma, Head of the Department of Medicine, All India Institute of Medical Sciences, New Delhi, and A. Mohan of the Department of Emergency Medicine, Venkateswara Institute of Medical Sciences, Tirupati, wrote that in their 2004 article 'Sarcoidosis in India: Not so Rare!' published in the Journal, Indian Academy of Clinical Medicine.
According to Prof. Sharma et al., sarcoidosis affected the lungs in 90% of confirmed cases in India - another reason why doctors often confuse sarcoidosis with TB, which also affects the lungs usually, though it can affect other parts of the body too.
Treatment of sarcoidosis
“Many-a-times, sarcoidosis improves without treatment. Up to 30% of patients with sarcoidosis get better on their own. If symptoms persist, a doctor may prescribe corticosteroids to suppress the immune system,” explained Dr Pandey. “There can be some complications like lung failure in very severe cases. But by and large, the bigger issue is the misdiagnosis of this condition as TB,” he added.
In 2018, Srijna Rana et al wrote an article on why it’s still so difficult to differentiate between TB and sarcoidosis. “...respiratory symptoms are common to both conditions. Similar ocular (related to the eye) manifestations such as dry eye and bilateral lacrimal gland enlargements can be seen in both sarcoidosis and TB. In the Indian context, the presence of serpiginous-like choroiditis is more likely to be associated with TB than with sarcoidosis. Similarly, sarcoidosis always involved lung and mediastinal lymph nodes, showing non-caseous granulomas," they wrote in 'A Case of Pulmonary Sarcoidosis Misdiagnosed as Tuberculosis'.
Lacrimal glands are present in the eyes - they are responsible for forming the watery layer in the tear film. Serpiginous choroiditis is a rare eye disorder. Typically, patients get lesions on parts of the retina and the layer behind it - the choroid. And the mediastinum is the central part of the chest that contains the heart, aorta, oesophagus, thymus (part of the immune system), trachea, lymph nodes and nerves.
“Differentiating sarcoidosis from TB in countries with a high burden of the latter, therefore, requires a high index of clinical suspicion for both diseases, clinical acumen, and detailed evaluation that should include a thorough evaluation of clinical, radiologic and laboratory findings,” Rana et al wrote.
"We have so many diagnostic tests also available, now," said Dr Pandey. "We just need to be more aware of the possibility that something which looks like TB could also be sarcoidosis."
Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. To know more on this topic, please visit https://www.myupchar.com/en/disease/sarcoidosis
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Updated Date: Sep 11, 2019 12:23:24 IST
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