Granulomatous disease: Difference between revisions
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(Created page with "== 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 == * Tuberculosis...") |
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== Differential Diagnosis == |
== Differential Diagnosis == |
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+ | * Infections |
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+ | * Mycobacteria |
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+ | ** [[Non-tuberculous mycobacteria]] |
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+ | ** [[Buruli ulcer]] ([[Mycobacterium ulcerans]]) |
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+ | ** BCG vaccination |
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+ | * Fungi: [[histoplasmosis]], [[coccidiomycosis]], [[blastomycosis]], [[sporotrichosis]], aspergillosis |
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+ | * , [[cryptococcosis]] |
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+ | * Protozoa: [[toxoplasmosis]], [[schistosomiasis]] |
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+ | * Spirochetes |
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+ | ** [[Treponema carateum]] |
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+ | ** [[Treponema pertenue]] |
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+ | * Bacteria |
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+ | ** [[Brucella]], [[Yersinia]], [[Whipple diseaes]] |
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+ | * Vasculitis: [[GPA]], [[EGPA]], [[lymphomatoid vasculitis]], [[polyarteritis nodosa]], [[bronchocentric vasculitis]], [[giant cell arteritis]], [[systemic lupus erythematosus]] |
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+ | * Other inflammatory disorders: |
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+ | ** [[Primary biliary cirrhosis]], [[hepatic granulomatous disease]], [[Langerhan granulomatosis]], [[Peyronie disease]], [[Blau syndrome]], [[hypogammaglobulinemia]], [[Langerhan cell histiocytosis]], [[immune complex disease]] |
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+ | * Leukocyte oxidase defects: [[chronic granulomatous disease]] |
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+ | * [[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 |
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+ | * Chemical exposures: beryllium, zirconium, silica, starch, talc |
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+ | * Neoplasms: carcinoma, reticulosis, pinealoma, dysgerminoma, seinoma, reticulum cell sarcoma, malignant nasal granuloma |
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+ | * Miscellaneous: [[lymphogranuloma]], [[Kikuchi syndrome]] |
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+ | == Further Reading == |
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+ | * 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] |
Revision as of 11:10, 2 November 2022
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
- 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
Further Reading
- James DG. A clinicopathological classification of granulomatous disorders. Postgrad Medical J. 2000;76:457-465. doi: 10.1136/pmj.76.898.457