Misdiagnosis and Literature Review of Pulmonary Sarcoidosis with Chest Tightness and Shortness of Breath as Main Symptoms

LI Mengcong; WANG Na; WANG Guangdong; LIU Tingting; JI Wenwen; SHI Zhihong

doi:10.3969/j.issn.1002-3429.2025.04.003

Abstract：Objective To explore the causes of misdiagnosis of pulmonary sarcoidosis(PS)as pulmonary tuberculo-sis and preventive measures.Methods The clinical treatment process of a PS patient who was misdiagnosed with pulmonary tuberculosis in May 2023 was analyzed,and the causes of misdiagnosis and preventive measures based on relevant literature were analyzed.Results The main symptoms of the patient were intermittent chest tightness and shortness of breath.Chest CT indicated the possibility of bilateral secondary pulmonary tuberculosis,and the patient was diagnosed with pulmonary tubercu-losis.At 10 months after anti-tuberculosis treatment with Isoniazid+Rifampicin+Ethambutol,the symptoms were not alle-viated significantly.Laboratory examination,chest CT and tracheoscopy were performed,and tissues and cells were taken for pathological examination,which revealed granulomatous inflammation of bronchial mucosa.Finally,after multidisciplinary di-agnosis and treatment,PS was considered for diagnosis,and the duration of misdiagnosis was 11 months.After diagnosis,oral Prednisone tablet(25 mg,1/d)was given,and gradually reduced regularly for 10 months.The patient visited the doctor reg-ularly,and reported that the symptoms were relieved.Reexamination of chest CT showed mediastinal enlargement,gradual re-duction of lymph nodes,multiple lung cord shadows,gradual improvement of pleural effusion,and improvement in pulmonary function.The drug has been discontinued for 2 months and is under follow-up.Conclusion Most of the symptoms of PS pa-tients are non-specific and belong to exclusive diagnostic diseases.Detailed history collection,physical examination and auxil-iary examination should be actively performed for diagnosis,and multidisciplinary diagnosis and treatment should be carried out when necessary to reduce misdiagnosis.