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Tuberculomas have been grouped into three types based on MRI findings and include non-caseating, caseating with solid centre and caseating with central necrosis.
The non infectious granulomas are non caseating nacked sarcoid granulomas of unknown etiology with numerous activated macrophages, few lymphocytes and scattered asteroid body or conchoids body.
The widely used Balb/c and C57BL/6 mouse strains do not exhibit caseating granuloma formation following Mtb infection (Orme and Basaraba, 2014) and manifest a chronic phase of disease unlike latent Mtb infection in humans (Rhoades et al.
Histopathological examination of the ulcerated area revealed several coalescing and caseating epithelioid granulomas in the lamina propria and submucosa [Figure 3].
3%) diagnosed in lymph node swellings was Caseating granulomas (57/86 cases) consistent with tuberculosis followed by reactive lymphadenitis (20 cases; 23.
Based on imaging tuberculomas can be categorized into noncaseating, caseating with solid center, or caseating with a liquid center.
Caption: FIGURE 4: Histological examination revealing caseating granulomatous inflammation.
Calcification was observed in areas of caseating central necrosis (Figures 2(a) and 2(b)).
Investigations may reveal an increased ESR, CRP, positive Mantoux test and TB-PCR but diagnosis is established by culture or a biopsy showing caseating granulomas lined by epitheloid cells and Langhans giant cells, The interferon gamma test by T-SPOT has been reported in literature for making a diagnosis (3).
The patient had previously been prescribed anti-TB treatment for suspected tuberculosis in another center based on caseating granuloma found in bone marrow aspiration by pathology and fever had subsided after 48 h; however PPD and PCR for TB was not conclusive and HIV test was negative.
Therefore, cases with typical radiographic features and isolation of a caseating granuloma from the tissues should be considered tuberculosis and treated accordingly until proven otherwise.
The biopsy report was extensive non- caseating naked epithelioid cell granulomas with no LT bodies and PAS stain negative for fungi" (Figure 2).
Caseating granuloma of tuberculosis can be seen in Fig.
Secondary disease causes ulcerated lesions of caseating foci within the mucosa and submucosa.
Granuloma formation with caseating necrosis should also point towards a differential diagnosis of infectious etiology as opposed to MCD.