Necrotising sarcoid granulomatosis—a covert disease in mycobacterial infection-endemic area: A case report

Sarcoidosis is a multisystem illness with an unclear aetiology. The characteristic feature is non-necrotising granulomas in various organs. Rarely, sarcoidosis can present as a case of necrotising granulomas. The objective of this report is to highlight this unusual manifestation of the disease. This report presents the case of a 62-year-old male with a confirmed diagnosis of sarcoidosis. The patient presented with prolonged history of fever without obvious aetiology; anti-tuberculous therapy did not prove helpful. Imaging revealed nodular infiltrations in the liver, spleen, and bone marrow. Upon biopsy histological features were consistent with necrotising granulomatous inflammation. Treatment was started with corticosteroids and the patient’s condition began to improve. The patient is currently recovering and is on follow-up. Early diagnosis and treatment of sarcoidosis is crucial for better prognosis. This case highlights the need to consider sarcoidosis in the differential diagnosis of fever of unknown origin and necrotising granulomatous inflammation involving multiple organs.