School of Medicine and Health Sciences Poster Presentations

Title

Sarcoidosis with Caseating Granulomas and Little Red Rods

Document Type

Poster

Keywords

tuberculosis; sarcoid; differential; granuloma; lymph node; mycobacteria; culture; quantiferon gold

Publication Date

Spring 2017

Abstract

The paradigm that mycobacterial granulomas are caseating and sarcoid granulomas are noncaseating can lead to a quandary when faced with the patient with classic neurosarcoidosis symptoms but mediastinal lymph nodes with caseating granulomas. We present a case of a 47-year-old man who presented with classic neurosarcoidosis symptoms, negative quantiferon gold test, and negative standard mycobacterial culture, but had caseating granulomas and clusters of red rods on acid-fast special stain in his excisional mediastinal lymph node biopsy. With a differential between sarcoidosis and mycobacterial infection, treating for one condition could worsen the other. We review the numerous contradictory test results and their significance based on the literature. Deviations from expected results should be kept in mind, especially due to the very significant treatment differences for infectious versus inflammatory conditions.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

1

Comments

Poster to be presented at GW Annual Research Days 2017.

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Sarcoidosis with Caseating Granulomas and Little Red Rods

The paradigm that mycobacterial granulomas are caseating and sarcoid granulomas are noncaseating can lead to a quandary when faced with the patient with classic neurosarcoidosis symptoms but mediastinal lymph nodes with caseating granulomas. We present a case of a 47-year-old man who presented with classic neurosarcoidosis symptoms, negative quantiferon gold test, and negative standard mycobacterial culture, but had caseating granulomas and clusters of red rods on acid-fast special stain in his excisional mediastinal lymph node biopsy. With a differential between sarcoidosis and mycobacterial infection, treating for one condition could worsen the other. We review the numerous contradictory test results and their significance based on the literature. Deviations from expected results should be kept in mind, especially due to the very significant treatment differences for infectious versus inflammatory conditions.