BMJ Case Reports 2012; doi:10.1136/bcr.05.2011.4278
  • Rare disease

Systemic sarcoidosis with caseating granuloma

  1. Hossein Navabii3
  1. 1Pathology Department, Shahid Sadoghi University, Yazd, Islamic Republic of Iran
  2. 2Internal Medicine Department, Shahid Sadoghi University, Yazd, Islamic Republic of Iran
  3. 3Shahid Sadoghi Hospital, Yazd, Islamic Republic of Iran
  1. Correspondence to Dr Fariba Binesh, binesh44{at}


Sarcoidosis is a multi-systemic disease, the diagnosis of which depends on the presence of non-necrotising granulomas in a biopsy specimen. However, variants such as necrotising sarcoid granuloma make it difficult to differentiate the disease from other infectious processes, especially tuberculosis. Here the authors describe the case of a 58-year-old Iranian woman who developed granulomas with extensive necrosis in a systemic sarcoidosis that affected the lung, liver and spleen. These findings led to a diagnosis of tuberculosis and delayed appropriate treatment.


  • Competing interests None.

  • Patient consent Obtained.

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