Granulomatous disease: Difference between revisions

Latest revision as of 17:50, 19 May 2023

Background

Granulomatous inflammation is chronic inflammation that involves macrophages and T lymphocytes to wall off an infectious organism
T cells are activated and in turn activate macrophages, which undergo morphological changes to become more epithelioid
Creates two main types of granulomas: foreign body granulomas, and immune ganulomas
- In immune granulomas, macrophages active T cells to produce IL-2

Differential Diagnosis

See also Granulomatous lung disease
Infections
- Mycobacteria
  - Tuberculosis: caseating granulomas, with acid-fast bacilli
  - Leprosy: non-caseating granulomas, with acid-fast bacilli in macrophages
  - Non-tuberculous mycobacteria
  - Buruli ulcer (Mycobacterium ulcerans)
  - BCG vaccination
- Fungi: histoplasmosis, coccidiomycosis, blastomycosis, sporotrichosis, aspergillosis, cryptococcosis
- Protozoa: toxoplasmosis, schistosomiasis
- Spirochetes
  - Syphilis: gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline
  - Treponema carateum
  - Treponema pertenue
- Bacteria
  - Cat scratch disease: rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon
  - Brucella, Yersinia, Whipple diseaes
Vasculitis: GPA, eGPA, lymphomatoid vasculitis, polyarteritis nodosa, bronchocentric vasculitis, giant cell arteritis, systemic lupus erythematosus
Other inflammatory disorders:
- Sarcoidosis: non-caseating granulomas with abundant activated macrophages
- Crohn disease: occasional non-caseating granulomas in intestinal wall
- Primary biliary cirrhosis, hepatic granulomatous disease, Langerhan granulomatosis, Peyronie disease, Blau syndrome, hypogammaglobulinemia, Langerhan cell histiocytosis, immune complex disease
Leukocyte oxidase defects: chronic granulomatous disease
Hypersensitivity pneumonitis: farmer's lung, bird fancier's lung, mushroom worker's lung, suberosis (cork dust), bagassosis, maple bark stripper's lung, paprika splitter's lung, coffee bean lung, Spatlese lung
Chemical exposures: beryllium, zirconium, silica, starch, talc
Neoplasms: carcinoma, reticulosis, pinealoma, dysgerminoma, seinoma, reticulum cell sarcoma, malignant nasal granuloma
Miscellaneous: lymphogranuloma, Kikuchi syndrome

@@ Line 8: / Line 8: @@
 == Differential Diagnosis ==
+* See also [[Granulomatous lung disease]]
-* [[Tuberculosis]]: caseating granulomas, with acid-fast bacilli
+* Infections
-* [[Leprosy]]: non-caseating granulomas, with acid-fast bacilli in macrophages
+** Mycobacteria
-* [[Syphilis]]: gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline
+*** '''[[Tuberculosis]]''': caseating granulomas, with acid-fast bacilli
-* [[Cat scratch disease]]: rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon
-* [[Sarcoidosis]]: non-caseating granulomas with abundant activated macrophages
+*** '''[[Leprosy]]:''' non-caseating granulomas, with acid-fast bacilli in macrophages
+*** [[Non-tuberculous mycobacteria]]
-* [[Crohn disease]]: occasional non-caseating granulomas in intestinal wall
+*** [[Buruli ulcer]] ([[Mycobacterium ulcerans]])
+*** BCG vaccination
+** Fungi: [[histoplasmosis]], [[coccidiomycosis]], [[blastomycosis]], [[sporotrichosis]], [[aspergillosis]], [[cryptococcosis]]
+** Protozoa: [[toxoplasmosis]], [[schistosomiasis]]
+** Spirochetes
+*** '''[[Syphilis]]''': gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline
+*** [[Treponema carateum]]
+*** [[Treponema pertenue]]
+** Bacteria
+*** '''[[Cat scratch disease]]''': rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon
+*** [[Brucella]], [[Yersinia]], [[Whipple diseaes]]
+* Vasculitis: [[GPA]], [[EGPA]], [[lymphomatoid vasculitis]], [[polyarteritis nodosa]], [[bronchocentric vasculitis]], [[giant cell arteritis]], [[systemic lupus erythematosus]]
+* Other inflammatory disorders:
+** '''[[Sarcoidosis]]''': non-caseating granulomas with abundant activated macrophages
+** [[Crohn disease|'''Crohn disease''']]: occasional non-caseating granulomas in intestinal wall
+** [[Primary biliary cirrhosis]], [[hepatic granulomatous disease]], [[Langerhan granulomatosis]], [[Peyronie disease]], [[Blau syndrome]], [[hypogammaglobulinemia]], [[Langerhan cell histiocytosis]], [[immune complex disease]]
+* Leukocyte oxidase defects: [[chronic granulomatous disease]]
+* [[Hypersensitivity pneumonitis]]: farmer's lung, bird fancier's lung, mushroom worker's lung, suberosis (cork dust), bagassosis, maple bark stripper's lung, paprika splitter's lung, coffee bean lung, Spatlese lung
+* Chemical exposures: beryllium, zirconium, silica, starch, talc
+* Neoplasms: carcinoma, reticulosis, pinealoma, dysgerminoma, seinoma, reticulum cell sarcoma, malignant nasal granuloma
+* Miscellaneous: [[lymphogranuloma]], [[Kikuchi syndrome]]
+== Further Reading ==
+* James DG. A clinicopathological classification of granulomatous disorders. ''Postgrad Medical J''. 2000;76:457-465. doi: [https://doi.org/10.1136/pmj.76.898.457 10.1136/pmj.76.898.457]