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Features favoring TB were the quotidian fever pattern, caseating granulomas, symptomatic response to anti-TB therapy and absence of distal bronchopulmonary lymphadenopathy.
In patients with HIV, and more specifically AIDS, the histological changes caused by MTB can range from the classic caseating granulomas, to a nonspecific chronic inflammatory reaction without necrosis.
Subsequent core biopsy has shown this to be a caseating granuloma in keeping with Tuberculosis infection.
Mycobacterial infection often manifests specific histologic changes, as Mycobacterium tuberculosis infection induces caseating granulomas whereas Mycobacterium avium-intra-cellulare generates aggregates of foamy macrophages.
Later histopathological examination of the cerebellar SOL showed caseating granuloma (white arrow) and multinucleated Langhans' type of giant cells suggestive of tuberculoma of the left cerebellar hemisphere.
Surgical biopsy of the right lung found caseating granulomata, but culture was negative.
The diagnosis was established on the basis of atleast one of the following criteria: histological evidence of caseating granuloma, microscopic demonstration of acid-fast bacilli in the lesion, growth of mycobacterium on culture of tissue specimen, therapeutic response to drug therapy in patients with clinical, or radiological and operative evidence of spinal TB.
Histologically, destructive caseating granulomas are strongly supportive of TB, but acid-fast bacteria are noted in less than half of tissue sections or needle aspirates.
2-3) Spinal deformity is closely related with the destructive nature of caseating granuloma and is an important diagnostic clue when present.
The diagnosis of TB was established by one or more of the following: (i) positive smear and/ or culture for Mycobacterium tuberculosis of sputum (pulmonary) or extrapulmonary tissue or fluid; (ii) histological finding of caseating granuloma or acid-fast bacilli in extrapulmonary tissue (peripheral lymph node biopsy/aspirate) or fluid (pleural or ascitic); and (iii) highly corroborative clinical picture with response to antituberculosis treatment.
If bronchoscopy results showed acid-fast bacteria and caseating granulomas, the diagnosis of tuberculosis would be secured.
In AIDS, the histological changes caused by Mycobacterium tuberculosis can range from the classical caseating granulomas, to a non-specific chronic inflammatory reaction without necrosis.
Sections from the growth showed granuloma formation along with areas of caseating necrosis and Langhans type giant cells, suggestive of tuberculosis (Fig.
It is characterized by well-formed granulomas, with or without caseating necrosis, and/or sheets of histiocytes.