Tuberculosis vs Sarcoidosis
Tuberculosis and Sarcoidosis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Tuberculosis vs Sarcoidosis at a glance
- Tuberculosis: Mycobacterium tuberculosis infection — active disease or asymptomatic latent infection (LTBI).
- Sarcoidosis: Multisystem non-caseating granulomatous disease most commonly involving lungs and lymph nodes.
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Side-by-side comparison
| Feature | Tuberculosis | Sarcoidosis |
|---|---|---|
| At a glance | Mycobacterium tuberculosis infection — active disease or asymptomatic latent infection (LTBI). | Multisystem non-caseating granulomatous disease most commonly involving lungs and lymph nodes. |
| Classic presentation | Apical/posterior upper lobe or superior segment of lower lobe cavitary disease (reactivation); hilar lymphadenopathy + middle/lower lobe infiltrate (primary); miliary nodules (2-3 mm) on CXR (disseminated).; LTBI: asymptomatic by definition; Active pulmonary TB: chronic cough >3 weeks (productive, may be hemoptysis), drenching night… | Bilateral hilar lymphadenopathy on CXR in young African American or northern European patient; Löfgren triad; lupus pernio; bell's-like facial palsy.; Pulmonary: dry cough, dyspnea, chest discomfort (~90% have lung involvement at some point); Constitutional: fatigue, fever, weight loss, night sweats; Skin: erythema nodosum, lupus pernio… |
| Workup / key labs | LTBI: positive TST (induration ≥5/10/15 mm cutoff based on risk) or positive IGRA + no active disease on imaging/clinical evaluation. Active TB: clinical findings + positive AFB smear/NAAT/culture from respiratory or other site.; LTBI: tuberculin skin test (TST/PPD) OR interferon-gamma release assay (IGRA — QuantiFERON, T-SPOT); Active… | Clinical/radiographic presentation + biopsy showing non-caseating granulomas + exclusion of alternative causes. Löfgren syndrome and asymptomatic Stage I CXR in a young patient may be diagnosed clinically without biopsy.; ACE level — elevated in ~60%, neither sensitive nor specific (poor diagnostic value); CBC (lymphopenia, mild… |
| Imaging | CXR — primary: hilar adenopathy, middle/lower infiltrate, Ghon complex; reactivation: apical/posterior cavitary lesions; miliary: 2-3 mm nodules diffuse; CT chest if CXR equivocal or to characterize disease; MRI brain/spine if neurologic/spinal TB suspected | Chest radiograph — Scadding stage (0-IV): 0 normal; I bilateral hilar adenopathy; II hilar adenopathy + parenchymal disease; III parenchymal only; IV fibrosis; HRCT chest — perilymphatic micronodular pattern (along bronchovascular bundles, fissures, subpleural), bilateral symmetric hilar/mediastinal adenopathy; PET/CT — identifies… |
| First-line treatment | LTBI (CDC 2020 preferred shorter regimens): isoniazid + rifapentine weekly × 12 weeks (3HP, DOT); OR rifampin daily × 4 months (4R); OR isoniazid + rifampin daily × 3 months (3HR); LTBI alternative: isoniazid daily × 6 or 9 months (older standard; longer, more hepatotoxicity); Active drug-susceptible TB (RIPE × 2 months intensive… | Many patients require no treatment — spontaneous remission in ~50% within 2-5 years; Indications for systemic therapy: progressive pulmonary disease, symptomatic Stage II/III, cardiac involvement, neurosarcoidosis, ocular disease unresponsive to topical therapy, hypercalcemia, severe constitutional symptoms; Corticosteroids —… |
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