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Increased Serum Sedimentation and Positive Tuberculosis Antibody Combined Multiple Pulmonary Nodules in Chest CT in a Middle-Aged Patient Firstly Misdiagnosed as Tuberculosis Proved as Sarcoidosis by CT Guided Percutaneous Lung Puncture Biopsy: a Case Report and Literature Review by Xiao Y. Zhu, Wen Q. Li, Yi Chen, Meng H. Wang, Qian Zhang, Cong H. Liu, Hai F. Zhang, Chen Hao, Ci Zhang, Li Q. Li, Ai S. Fu, Yan L. Ge

Background: Tuberculosis is a common infectious disease in developing countries. Tuberculosis and sarcoidosis are difficult to differentiate. We presented an adult case with increased serum sedimentation and positive tuberculosis antibody combined with multiple pulmonary nodules in chest CT in a middle-aged patient firstly misdiagnosed as tuberculosis proved as sarcoidosis by CT guided percutaneous lung puncture biopsy.
Methods: Appropriate laboratory tests are carried out. The chest CT scan, bronchoscopy CT guided percutaneous lung puncture biopsy were performed for diagnosis.
Results: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed multiple pulmonary nodules in both lungs and multiple lymphadenopathy. The bronchoscopy demonstrated no abnormality. Pathology of CT guided percutaneous lung puncture biopsy showed non-caseous multiple granulomatous lesions and acid-fast staining was negative.
Conclusions: When a patient has multiple pulmonary nodules and lymphadenopathy without obvious tuberculosis poisoning symptoms, physicians should pay attention to tuberculosis, sarcoidosis, and lung cancer. Pathology is crucial for the ultimate diagnosis.

DOI: 10.7754/Clin.Lab.2019.190325