CRA75 SUCCESSFUL TRANSBRONCHIAL LUNG BIOPSY: UNRAVELING THE DIAGNOSTIC MYSTERY IN A PATIENT TREATED FOR RECURRENT TUBERCULOSIS

¹Nurul Aimi Abd Ghani, ¹Umadevi A Muthukumaru, ²Lee Fong Wan

¹Respiratory Department, Hospital Pulau Pinang, ²Pathology Department Hospital Pulau Pinang, Penang, Malaysia

INTRODUCTION
Sarcoidosis and tuberculosis are chronic granulomatous diseases with similar signs, making diagnosis difficult in areas where tuberculosis is common. Flexible bronchoscopy and transbronchial lung biopsy (TBLB) have a high diagnostic success rate of 40% to 90%. However, more invasive methods may be needed, such as endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) or surgical lung biopsy.

CASE PRESENTATION
We present a 36-year-old man with cough, fever, chest pain, and dyspnoea. A 2021 CT scan revealed ground-glass opacities and enlarged lymph nodes. Initial bronchoscopy provided a suboptimal biopsy, while EBUS-TBNA indicated granulomatous inflammation. After stopping treatment for 5 months, he returned with worsening symptoms and CT signs of miliary disease. A skin biopsy suggested granulomatous dermatitis, and he resumed treatment for another 10 months. Three years later, pleuritic chest pain and cough led to another bronchoscopy, which returned negative results for acid-fast bacilli and the TB GeneXpert test. Anti-TB therapy restarted in March 2025 but showed no improvement. A repeat bronchoscopy and TBLB revealed granulomatous inflammation typical of sarcoidosis, confirmed by CT. The patient started on prednisolone 30 mg daily and showed improvement.

DISCUSSION
Diagnosing sarcoidosis involves clinical, radiological, and histological criteria, necessitating the exclusion of other conditions. Distinguishing it from tuberculosis is vital to avoid misdiagnosis and unnecessary treatments.

CONCLUSION
This case highlights the importance of considering sarcoidosis in patients with granulomatous lesions that do not respond to anti-tuberculosis treatment. Bronchoscopic techniques effectively diagnose sarcoidosis and lower the need for more invasive procedures.