To the Differential Diagnostics of Focal Pneumonia, Tuberculosis and Sarcoidosis (Clinical Case)

Despite the significant advances in modern medicine, the issue of differential diagnosis of diseases of the bronchopulmonary system remains a complex and urgent problem in the practical work of physicians.Of particular importance are the pathological processes that are part of the "pulmonary dissemination syndrome", which, according to the literature, includes more than 200 diseases.Most of them are not common in clinical practice, but this syndrome also includes pulmonary dissemination, which is most common in clinical practice.These include focal pneumonia, disseminated pulmonary tuberculosis, and sarcoidosis, which are united by an X-ray pattern of dissemination for the differential diagnosis of which clinical manifestations are not enough, and more accurate examination methods are required.This clinical observation is a clear illustration of how difficult it is to manage a patient in the absence of etiological confirmation of the diagnosis.In such circumstances, only adherence to the differential diagnostic algorithm, based on the choice of a working diagnosis based on the frequency of the pathological process among similar diseases, makes it possible to avoid serious consequences.The lack of effect from the treatment of focal pneumonia was a criterion for the erroneousness of the first working diagnosis, which was the basis for the diagnosis of disseminated tuberculosis.The effectiveness of anti-TB therapy was the only confirmation of the correctness of the diagnosis.It was only the repeated early relapse of the disease that gave rise to the suspicion that the patient had sarcoidosis.An in-depth histological examination of biopsies of lymph nodes, bronchial mucosa and lung tissues, combined with molecular genetic testing of the patient, confirmed that the patient had a combination, and possibly an etiological relationship, of these two granulomatoses.Adherence to the algorithm of differential diagnostic management of the patient made it possible to identify such a complex combination of diseases on time and prescribe a complete treatment.