Histologic tuberculosis eventually turned out to be necrotizing sarcoid granulomatosis, a rare disease. A retired TB ward nurse with recurrent uveitis, a positive TST, pulmonary masses and skeletal pain was diagnosed with clinical tuberculosis (TB) and treated with first line tuberculostatic drugs, but the chest X-ray did not improve after treatment completion. Ensuing reassessment of the pulmonary biopsy resulted in a diagnosis of pulmonary necrotizing sarcoid granulomatosis (NSG) and concurrent ankylosing spondylitis (AS), a very rare combination of inflammatory diseases. Uveitis can be a symptom of TB or AS or NSG, the last being a rare disorder of unknown etiology, mimicking tuberculosis.
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