Granulomatous disease: Difference between revisions
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== Differential Diagnosis == |
== Differential Diagnosis == |
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+ | * See also [[Granulomatous lung disease]] |
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* Infections |
* Infections |
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− | * Mycobacteria |
+ | ** Mycobacteria |
− | ** '''[[Tuberculosis]]''': caseating granulomas, with acid-fast bacilli |
+ | *** '''[[Tuberculosis]]''': caseating granulomas, with acid-fast bacilli |
− | ** '''[[Leprosy]]:''' non-caseating granulomas, with acid-fast bacilli in macrophages |
+ | *** '''[[Leprosy]]:''' non-caseating granulomas, with acid-fast bacilli in macrophages |
− | ** [[Non-tuberculous mycobacteria]] |
+ | *** [[Non-tuberculous mycobacteria]] |
− | ** [[Buruli ulcer]] ([[Mycobacterium ulcerans]]) |
+ | *** [[Buruli ulcer]] ([[Mycobacterium ulcerans]]) |
− | ** BCG vaccination |
+ | *** BCG vaccination |
− | * Fungi: [[histoplasmosis]], [[coccidiomycosis]], [[blastomycosis]], [[sporotrichosis]], aspergillosis |
+ | ** Fungi: [[histoplasmosis]], [[coccidiomycosis]], [[blastomycosis]], [[sporotrichosis]], aspergillosis |
* , [[cryptococcosis]] |
* , [[cryptococcosis]] |
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− | * Protozoa: [[toxoplasmosis]], [[schistosomiasis]] |
+ | ** Protozoa: [[toxoplasmosis]], [[schistosomiasis]] |
− | * Spirochetes |
+ | ** Spirochetes |
− | ** '''[[Syphilis]]''': gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline |
+ | *** '''[[Syphilis]]''': gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline |
− | ** [[Treponema carateum]] |
+ | *** [[Treponema carateum]] |
− | ** [[Treponema pertenue]] |
+ | *** [[Treponema pertenue]] |
− | * Bacteria |
+ | ** Bacteria |
− | ** '''[[Cat scratch disease]]''': rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon |
+ | *** '''[[Cat scratch disease]]''': rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon |
− | ** [[Brucella]], [[Yersinia]], [[Whipple diseaes]] |
+ | *** [[Brucella]], [[Yersinia]], [[Whipple diseaes]] |
* Vasculitis: [[GPA]], [[EGPA]], [[lymphomatoid vasculitis]], [[polyarteritis nodosa]], [[bronchocentric vasculitis]], [[giant cell arteritis]], [[systemic lupus erythematosus]] |
* Vasculitis: [[GPA]], [[EGPA]], [[lymphomatoid vasculitis]], [[polyarteritis nodosa]], [[bronchocentric vasculitis]], [[giant cell arteritis]], [[systemic lupus erythematosus]] |
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* Other inflammatory disorders: |
* Other inflammatory disorders: |
Revision as of 10:13, 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
- Mycobacteria
- , 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