Systemic sarcoidosis in a TB-endemic region: diagnostic role of linear endobronchial ultrasound mediastinal lymph node cryobiopsy and stepwise management approach

Sarcoidosis is a multisystem granulomatous disease that can mimic tuberculosis (TB) or lymphoma, particularly in endemic regions. We report a man in his late 50s with chronic cough, weight loss and systemic features whose CT showed mediastinal and abdominal lymphadenopathy with splenic lesions. Histology from endobronchial ultrasound-guided transbronchial cryobiopsy revealed non-caseating granulomas, confirming sarcoidosis and excluding TB and malignancy. He responded well to corticosteroids with methotrexate as a steroid-sparing agent. This case emphasises the diagnostic challenge of sarcoidosis in TB-endemic regions and highlights the added value of cryobiopsy in obtaining adequate tissue for diagnosis.