Systemic sarcoidosis with caseating granuloma

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.