Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Do Sarcoidosis And Hansen Disease Have Symptoms Of Patches On The Skin?
Question: Hello Doctors,
My mom has been getting treatment for lymph node TB and brain TB. She had swelling of lymph nodes couple of years back and was tested for lymph node TB and then she had seizure, an brain MRI scan revealed inflammation, from which doctors concluded she also has brain TB , In the last 6 months she has developed, patches on her hand, back. Lumps on her forehead, slight disfigurement of her nose etc
The doctor wants to test her for sarcoidosis and neurosarcoidosis.
(1) Are there any conclusive tests for sarcoidosis, if so what are they?
(2) Is it possible for it to be sarcoidosis and not TB?
(3) Do sarcoidosis and hansen diseas have similar symptoms? how can they be distinguised?
Please let me know. Thank you.
My mom has been getting treatment for lymph node TB and brain TB. She had swelling of lymph nodes couple of years back and was tested for lymph node TB and then she had seizure, an brain MRI scan revealed inflammation, from which doctors concluded she also has brain TB , In the last 6 months she has developed, patches on her hand, back. Lumps on her forehead, slight disfigurement of her nose etc
The doctor wants to test her for sarcoidosis and neurosarcoidosis.
(1) Are there any conclusive tests for sarcoidosis, if so what are they?
(2) Is it possible for it to be sarcoidosis and not TB?
(3) Do sarcoidosis and hansen diseas have similar symptoms? how can they be distinguised?
Please let me know. Thank you.
Brief Answer:
Your answers as follows.
Detailed Answer:
I read your question carefully and I understand your concern. The answers to your questions as follows:
1. The most conclusive test for sarcoidosis is biopsy, taking a sample directly from the affected area and viewing it under a microscope, usually applying different stains. It can be taken from the skin but also from the meninges in the brain if result is inconclusive.
The Kveim test is another test but it is not widely available (involves injecting tissue from a sarcoidosis patient and obtaining later biopsy), not commonly applied these days also because of risk of infection.
Other tests such as imaging or blood tests help make the diagnosis but are not conclusive, as their specificity is not high (meaning changes may be caused by other conditions).
2. Yes, it seems possible from the current info for it to be sarcoidosis and not TB. Neurosarcoidosis can be difficult to distinguish from neuro TB, can manifest in similar ways. The pituitary and hypothalamus involvement is more common in sarcoidosis which is what has prompted the radiologist to suggest that possibility. Skin involvement is more common for sarcoidosis than TB as well (mind you again, not specific, TB may cause all that as well, hence the need for a biopsy).
3. As for Hansen disease, the skin manifestations may be similar at times, but I don't think that is the case as Hansen doesn't affect central nervous system as in your mother's case (may affect peripheral nerves but not commonly the brain).
I remain at your disposal for other questions.
Your answers as follows.
Detailed Answer:
I read your question carefully and I understand your concern. The answers to your questions as follows:
1. The most conclusive test for sarcoidosis is biopsy, taking a sample directly from the affected area and viewing it under a microscope, usually applying different stains. It can be taken from the skin but also from the meninges in the brain if result is inconclusive.
The Kveim test is another test but it is not widely available (involves injecting tissue from a sarcoidosis patient and obtaining later biopsy), not commonly applied these days also because of risk of infection.
Other tests such as imaging or blood tests help make the diagnosis but are not conclusive, as their specificity is not high (meaning changes may be caused by other conditions).
2. Yes, it seems possible from the current info for it to be sarcoidosis and not TB. Neurosarcoidosis can be difficult to distinguish from neuro TB, can manifest in similar ways. The pituitary and hypothalamus involvement is more common in sarcoidosis which is what has prompted the radiologist to suggest that possibility. Skin involvement is more common for sarcoidosis than TB as well (mind you again, not specific, TB may cause all that as well, hence the need for a biopsy).
3. As for Hansen disease, the skin manifestations may be similar at times, but I don't think that is the case as Hansen doesn't affect central nervous system as in your mother's case (may affect peripheral nerves but not commonly the brain).
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You for your response, Dr Olsi. I attached the blood ACE level report
(1) Is the report suggestive of Sarcoidosis? If yes, do we need a biopsy as well?
(2) Can we take the biopsy from the skin patches/rashes on her hands? Will that be conclusive?
Please let me know. Thank You
Brief Answer:
Suggestive of sarcoidosis, would take biopsy from skin
Detailed Answer:
Thank you for the additional information.
That blood ACE level is higher than the norm. It is another factor supporting the diagnosis of sarcoidosis. However it is not a definitive test, I still think a biopsy is advisable.
Yes the skin patches would be the first site where the biopsy sample should be taken given that it is the easiest access. If biopsy report confirms sarcoidosis, finds typical granuloma infiltration in the skin, that would be conclusive, wouldn't ask for more tests. However at times the biopsy doesn't find granulomas, skin changes from granulomas can be of different types, in some lesions the changes are not due to granuloma infiltration but due to an exaggerated response of the body to the infection, not due to skin infiltration itself, in that case granulomas may not be found. So if negative it doesn't exclude the diagnosis and would go ahead with brain biopsy.
I hope I was understandable. Let my know if I can further assist you.
Suggestive of sarcoidosis, would take biopsy from skin
Detailed Answer:
Thank you for the additional information.
That blood ACE level is higher than the norm. It is another factor supporting the diagnosis of sarcoidosis. However it is not a definitive test, I still think a biopsy is advisable.
Yes the skin patches would be the first site where the biopsy sample should be taken given that it is the easiest access. If biopsy report confirms sarcoidosis, finds typical granuloma infiltration in the skin, that would be conclusive, wouldn't ask for more tests. However at times the biopsy doesn't find granulomas, skin changes from granulomas can be of different types, in some lesions the changes are not due to granuloma infiltration but due to an exaggerated response of the body to the infection, not due to skin infiltration itself, in that case granulomas may not be found. So if negative it doesn't exclude the diagnosis and would go ahead with brain biopsy.
I hope I was understandable. Let my know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You Dr, Olsi. My mom is going through a few tests today, will get back to you if I have any further questions.
Brief Answer:
You're welcome. Do not hesitate to write again.
Detailed Answer:
You're welcome. Do not hesitate to write again.
You're welcome. Do not hesitate to write again.
Detailed Answer:
You're welcome. Do not hesitate to write again.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
