Granulomatous Inflammation: It’s Not Always Tuberculosis
Granulomatous inflammation is a common finding in biopsy samples, particularly in regions where tuberculosis (TB) is prevalent. While TB is a major cause, not every granulomatous reaction is due to tuberculosis. Mistaking every granulomatous lesion as TB can lead to misdiagnosis, unnecessary treatment, and delay in identifying more serious conditions such as malignancies or systemic fungal infections.
What Is Granulomatous Inflammation?
Granulomas are small nodules of immune cells that form in response to chronic inflammation. They act as the body’s defense mechanism to isolate harmful substances or infections it cannot eliminate easily. While TB is a leading cause, other infections and even non-infectious diseases can trigger granuloma formation.
Causes Other Than Tuberculosis
- Fungal Infections: Diseases like histoplasmosis, blastomycosis, and cryptococcosis can all present with granulomas on histopathology.
- Malignancies: Certain cancers, especially lymphomas, can mimic granulomatous inflammation.
- Autoimmune Diseases: Sarcoidosis and granulomatosis with polyangiitis are examples of immune-mediated granulomatous diseases.
- Foreign Body Reactions: Materials such as talc, sutures, or even inhaled particles can provoke granulomatous responses.
Why Correct Diagnosis Matters
In TB-endemic countries like India, clinicians often begin anti-TB treatment based solely on histopathology. However, starting TB treatment without confirming the diagnosis can be dangerous:
- Delays appropriate care if the cause is fungal, malignant, or autoimmune.
- Leads to unnecessary side effects and drug resistance.
- Causes emotional and financial burden on patients and families.
What Should Be Done?
A thorough clinical evaluation, imaging studies, and additional lab tests (like fungal cultures, molecular diagnostics, or special stains) are crucial before initiating any therapy. Multidisciplinary input, including from infectious disease specialists, is often necessary.
When in Doubt, Consult an Expert
If your biopsy shows granulomatous inflammation, but the clinical picture doesn’t match TB, don’t rush into treatment. Consult a specialist to avoid misdiagnosis.
Dr. Chhavi Gupta
MBBS, MD, DM (AIIMS, New Delhi)
Senior Consultant – Infectious Diseases
Yashoda Super Speciality Hospital, Kaushambi
📞 For Appointments: +91 8851 346 424
🌐 More Info: drchhavigupta.com