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Pathology›Condition·Updated Jul 11, 2026·v1

Granulomatous Inflammation

Granulomatous inflammation is a chronic inflammatory pattern characterized by granulomas; diagnosis requires tissue biopsy with special stains and cultures, and management depends on the underlying etiology, antimicrobials for infection, immunosuppression for autoimmune causes, and removal of inciting material for foreign body reactions.

High Evidence92 references·1,760 words·8 min read·v1
granulomatous inflammationpathologysarcoidosistuberculosisANCA-associated vasculitisgranuloma annulareforeign body granuloma

Quick Reference

RxDrug of choiceFor non-infectious granulomatous inflammation (e.g., sarcoidosis): prednisone 0.5-1 mg/kg/day tapered to lowest effective dose. For EGPA: benralizumab 30 mg SC every 4 weeks or mepolizumab 300 mg SC every 4 weeks.
AltAlternativesSarcoidosis: methotrexate, azathioprine, infliximab. EGPA: rituximab, cyclophosphamide. Granuloma annulare: hydroxychloroquine, phototherapy, dapsone, TNF inhibitors.
⊘AvoidTNF inhibitors in active untreated tuberculosis; non-dihydropyridine CCBs in sarcoidosis with pulmonary hypertension; prolonged high-dose glucocorticoids without taper.
DxTest of choiceTissue biopsy with histology, special stains (AFB, GMS, PAS), culture, and PCR. For mediastinal adenopathy: EBUS-TBNA or EUS-FNA.
ScKey scoreBVAS (Birmingham Vasculitis Activity Score) for ANCA-associated vasculitis; ACE/sIL-2R for sarcoidosis (supportive).
→When to referRheumatology for vasculitis/sarcoidosis; infectious disease for TB/fungal; dermatology for cutaneous disease; ophthalmology for uveitis.
Granulomatous inflammation is a histologic pattern, not a diagnosis, always exclude infection before immunosuppression, and tailor therapy to the specific etiology.
Granulomatous inflammation is a pattern of chronic inflammation characterized by organized aggregates of epithelioid histiocytes, often with multinucleated giant cells and variable necrosis. It is a hallmark of infections (e.g., [[tuberculosis]]), autoimmune diseases (e.g., [[sarcoidosis]]), foreign body reactions, and drug-induced reactions. Diagnosis requires tissue biopsy with histologic examination, special stains, and microbiologic/serologic workup. Management targets the underlying cause, with immunosuppression for non-infectious etiologies.

Overview and Recommendations

Background

  • •Granulomatous inflammation is a morphologic pattern of chronic inflammation in which activated macrophages transform into epithelioid histiocytes and fuse to form multinucleated giant cells, creating compact, organized structures called granulomas. This tissue response occurs when the immune system cannot eliminate a persistent antigen, leading to a coordinated cellular reaction that may either contain the threat or become a site of ongoing tissue damage.
  • •The causes span infectious agents (most commonly worldwide, also endemic fungi, parasites, and bacteria such as ), autoimmune diseases ( , , ), foreign body reactions (silicone, PMMA fillers, suture material), and drug-induced reactions (immune checkpoint inhibitors, TNF inhibitors). In sarcoidosis, the incidence is 10-40 per 100,000 in the U.S. and Europe, with a lifetime risk of death from pulmonary fibrosis approaching 5%.
  • •Morphologic subtypes are the first branch point in diagnosis. Caseating granulomas (central acellular eosinophilic necrosis) are highly specific for mycobacterial or fungal infection. Non-caseating granulomas (no necrosis) characterize sarcoidosis, Crohn disease, and berylliosis. Suppurative granulomas (neutrophilic core) point to cat-scratch disease, lymphogranuloma venereum, or Yersinia. Necrotizing granulomas with vasculitis suggest granulomatosis with polyangiitis (GPA) or rheumatoid arthritis.
  • •The granuloma itself is a double-edged sword: protective containment of pathogens requires precise cytokine gradients (TNF-α, IFN-γ, IL-12), while excessive regulatory T-cell activity, TGF-β, and PD-L1 expression create an immunosuppressive niche that can permit pathogen persistence or drive fibrotic progression. In tuberculosis, the granuloma is an IFN-γ-depleted zone enriched for IDO1+ PD-L1+ myeloid cells, and peripheral PD-L1 expression correlates with progression to active disease and treatment response.
  • •Granulomatous inflammation is never a final diagnosis, it is a histologic pattern that demands a systematic search for etiology. The consequences of misdiagnosis are severe: labeling an infection as sarcoidosis and starting corticosteroids can cause disseminated tuberculosis or fungal disease; conversely, missing sarcoidosis leads to unnecessary antimicrobial therapy and delayed immunosuppression.

Evaluation

  • •Suspect granulomatous inflammation in any patient with a subacute or chronic illness characterized by cough, dyspnea, weight loss, night sweats, lymphadenopathy, hepatosplenomegaly, skin nodules or plaques, or unexplained organ dysfunction. The presenting symptoms depend on the organ system involved, pulmonary (most common), cutaneous, hepatic, neurologic, or gastrointestinal.
  • •Ask about travel history (endemic TB, histoplasmosis, coccidioidomycosis), exposure to tuberculosis, occupational exposures (beryllium, silica), cosmetic filler injections, surgical implants, medication list (especially immune checkpoint inhibitors, TNF inhibitors, anticonvulsants), and prior history of autoimmune disease or inflammatory bowel disease.
  • •Examine the skin for papules, plaques, nodules, lupus pernio (sarcoidosis), or palpable purpura (vasculitis). Palpate lymph nodes (cervical, supraclavicular, axillary, inguinal) and assess for hepatosplenomegaly. Perform a complete lung exam, looking for crackles or wheezing. In suspected neurosarcoidosis, assess cranial nerves, especially facial nerve palsy.
  • •Order tissue biopsy from the most accessible involved site as the gold-standard test. For mediastinal adenopathy, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) or endoscopic ultrasound-guided FNA (EUS-FNA) is recommended; sensitivity for sarcoidosis exceeds 85% and for tuberculosis approaches 86%. For skin lesions, punch biopsy is adequate. For hepatic granulomas, liver biopsy is required.
  • •Send biopsy tissue for histologic examination with hematoxylin and eosin staining to classify the granuloma type (caseating, non-caseating, suppurative, necrotizing). Always order special stains on every granuloma biopsy: Ziehl-Neelsen (AFB) for acid-fast bacilli, Gomori methenamine silver (GMS) for fungi, and periodic acid-Schiff (PAS) for fungi and Whipple disease. Gram stain and Warthin-Starry stain are added if suppurative or Bartonella is suspected.
  • •Send tissue for mycobacterial and fungal culture, and perform polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex, Bartonella, and Coxiella burnetii on fresh or paraffin-embedded tissue. In patients with unexplained granulomas, consider metagenomic next-generation sequencing.
  • •Obtain imaging: chest X-ray or high-resolution CT chest to look for bilateral hilar lymphadenopathy, perilymphatic nodules, or cavitary lesions. 18F-FDG PET/CT can identify metabolically active granulomas and guide biopsy. For filler-induced granulomas, high-frequency ultrasound (12-18 MHz) has a concordance rate of 85.7% with pathology.
  • •Perform serologic testing based on clinical context: serum angiotensin-converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R) for sarcoidosis (supportive but not diagnostic); ANCA (MPO and PR3) for vasculitis; QuantiFERON-TB Gold or T-SPOT.TB for latent tuberculosis; serologies for Brucella, Coxiella, Histoplasma, and Toxoplasma as indicated by exposure history.
  • •Diagnostic criteria for sarcoidosis require a compatible clinical and radiologic presentation, histologic evidence of non-caseating granulomas, and exclusion of other causes (infection, malignancy, foreign body). For tuberculosis, a positive AFB smear, culture, or PCR from a relevant specimen is diagnostic. For ANCA-associated vasculitis, positive ANCA with compatible histology (necrotizing granulomas with vasculitis) confirms the diagnosis.
  • •If initial biopsy is non-diagnostic but clinical suspicion remains high, perform a repeat biopsy. In laryngeal granulomas, up to 13% of patients require open biopsy after non-diagnostic microlaryngoscopy. Consider a trial of antimicrobial therapy if infection is suspected, but avoid empiric immunosuppression until infection is reasonably excluded.
  • •Also consider drug-induced granulomatous inflammation, which can appear months to years after starting the offending agent. A thorough medication history and temporal association with symptom onset should raise suspicion; withdrawal of the drug often leads to resolution.

Management

  • •First, treat the underlying cause. For infectious granulomatous diseases, initiate appropriate antimicrobial therapy. For pulmonary tuberculosis, use the 4-month all-oral regimen (rifampin, isoniazid, pyrazinamide, ethambutol for 2 months, then rifampin and isoniazid for 2 months) as recommended by ATS/CDC/ERS/IDSA 2025 guidelines. For drug-resistant TB, use bedaquiline, pretomanid, and linezolid ± moxifloxacin.
  • •For fungal infections (histoplasmosis, coccidioidomycosis, cryptococcosis), use itraconazole 200 mg PO BID or amphotericin B for severe disease, guided by species and susceptibility. For Bartonella (cat-scratch disease), azithromycin 500 mg PO once then 250 mg daily for 4 days is effective.
  • •For non-infectious granulomatous diseases, immunosuppression is the mainstay. For sarcoidosis, first-line therapy for symptomatic pulmonary disease is prednisone 0.5-1 mg/kg/day (max 40 mg/day) for 4-6 weeks, then taper by 5-10 mg every 2 weeks to a maintenance dose of 5-10 mg/day. Second-line agents include methotrexate 10-25 mg PO/SC weekly with folic acid 1 mg daily, or azathioprine 50-150 mg/day. Third-line: TNF inhibitors (infliximab 5 mg/kg IV at weeks 0, 2, 6, then every 8 weeks).
  • •For eosinophilic granulomatosis with polyangiitis (EGPA), initiate systemic glucocorticoids (prednisone 1 mg/kg/day, taper) and add an anti-IL-5/IL-5R biologic early. Benralizumab 30 mg SC every 4 weeks or mepolizumab 300 mg SC every 4 weeks are both effective; the MANDARA trial showed 2-year remission rates of 62-68% with prednisone ≤4 mg/day, and 44% achieved glucocorticoid-free status. Aim for prednisone ≤4 mg/day as the target.
  • •For granulomatosis with polyangiitis (GPA), use rituximab 375 mg/m2 IV weekly × 4 doses or cyclophosphamide 15 mg/kg IV every 2-3 weeks for induction, followed by rituximab 500 mg IV every 6 months or azathioprine 2 mg/kg/day for maintenance. Severe disease requires high-dose glucocorticoids (methylprednisolone 1 g IV daily × 3 days) then prednisone taper.
  • •For generalized granuloma annulare (GGA), first-line therapy is hydroxychloroquine 200-400 mg PO daily (monitor for retinopathy) or phototherapy (PUVA, UVA1, or narrowband UVB). For extensive disease, bridging with oral prednisone 0.5 mg/kg/day for 2-4 weeks plus high-potency topical steroids or calcineurin inhibitors. Second-line: dapsone 50-100 mg/day (check G6PD before starting) or oral retinoids (isotretinoin 0.5-1 mg/kg/day). Refractory cases may respond to TNF inhibitors (adalimumab 40 mg SC every 2 weeks) or JAK inhibitors (tofacitinib 5 mg BID).
  • •For subcutaneous granuloma annulare (SGA), which is predominantly pediatric, conservative management is appropriate because 87% improve spontaneously and 60% completely resolve. Surgical excision is effective for persistent nodules (68.1% resolution), but recurrence is possible. Intralesional triamcinolone 5-10 mg/mL can be used for non-resolving lesions.
  • •For Kimura disease, treatment options include surgical excision for localized disease, oral glucocorticoids (prednisone 0.5 mg/kg/day tapered), methotrexate 10-25 mg weekly, or low-dose radiotherapy (20-30 Gy). Pre-treatment absolute eosinophil count ≥1.77 × 10⁹/L predicts poorer outcomes and may warrant more aggressive therapy.
  • •For foreign body granulomas (e.g., from cosmetic fillers), first-line is removal of the inciting material if possible. Intralesional triamcinolone 5-10 mg/mL may reduce inflammation. For non-HA filler granulomas, noninvasive therapy (topical steroids, tacrolimus) is often sufficient; for HA filler granulomas, hyaluronidase injection can dissolve the filler. Surgical excision is reserved for refractory cases.
  • •Avoid the following: Initiating TNF inhibitors in patients with untreated latent TB without adequate prophylaxis (isoniazid 300 mg daily for 9 months or rifampin 600 mg daily for 4 months). Prolonged high-dose glucocorticoids without a taper plan. Using non-dihydropyridine calcium channel blockers in sarcoidosis with pulmonary hypertension, they worsen outcomes. Empiric immunosuppression without first excluding infection, especially in endemic areas.
  • •Monitor therapy: For patients on methotrexate, monitor LFTs, renal function, and CBC every 4-8 weeks. For azathioprine, check TPMT genotype before starting. For biologics, screen for hepatitis B, C, and TB before initiation. For hydroxychloroquine, baseline and annual ophthalmologic exams. For glucocorticoids, monitor blood glucose, bone density, and blood pressure.
  • •Refer to: Rheumatology for ANCA-associated vasculitis, sarcoidosis with extrapulmonary involvement, or refractory disease. Dermatology for cutaneous sarcoidosis, granuloma annulare, or filler complications. Infectious disease for suspected tuberculosis or fungal infections. Ophthalmology for uveitis in sarcoidosis. ENT for laryngeal or sinus granulomas. Cardiothoracic surgery for mediastinal biopsy or drainage of cholesterol granuloma.
  • •Discharge criteria for patients hospitalized with granulomatous disease: stable vital signs, ability to take oral medications, pain controlled, clear plan for outpatient follow-up and monitoring, and no evidence of active infection requiring IV therapy. For patients on immunosuppression, ensure Pneumocystis jirovecii prophylaxis (trimethoprim-sulfamethoxazole 80/400 mg daily) if on prednisone ≥20 mg/day for ≥1 month.

Board Review — High Yield

  • •Granuloma components, Epithelioid histiocytes, multinucleated giant cells (Langhans type: peripheral nuclei; foreign body type: scattered nuclei), lymphocytic rim.
  • •Caseating vs. non-caseating, Caseous necrosis is highly specific for TB and fungal infection; non-caseating points to sarcoidosis, Crohn disease, or berylliosis.
  • •Suppurative granuloma, Neutrophilic center; seen in cat-scratch disease (Bartonella), lymphogranuloma venereum, and Yersinia.
  • •Necrotizing granuloma with vasculitis, Hallmark of granulomatosis with polyangiitis (GPA); c-ANCA (PR3) positive in 90%.
  • •Sarcoidosis diagnosis, Requires compatible clinical/radiologic picture + non-caseating granulomas + exclusion of other causes; elevated ACE is supportive but not diagnostic.
  • •Tuberculosis granuloma, Contains Langhans giant cells and caseous necrosis; AFB stain positive; PD-L1+ myeloid cells create immunosuppressive niche.
  • •Foreign body granuloma, Polarizable material visible under polarized light; common culprits: silicone, PMMA, suture, talc.
  • •EGPA management, Anti-IL-5/IL-5R therapy (benralizumab or mepolizumab) plus glucocorticoids; aim for prednisone ≤4 mg/day.
  • •Drug-induced granulomatous reaction, Can occur months to years after drug initiation; suspect with temporal association and exclude other causes.
  • •Gold standard test, Tissue biopsy with histology, special stains (AFB, GMS, PAS), culture, and PCR.

Deep Dive — Evidence Details

References

  1. [1]

    Chan PK, Yen WT, Chen PH. “Efficacy of Topical Beta-Blockers in Managing Epidermal Growth Factor Receptor Inhibitor-Related Paronychia and Pyogenic Granuloma-Like Lesion: A Systematic Review and Meta-Analysis.” Cancer medicine (2026). PMID: 41588796 ↗

    L1SR_OBSCited in: Definition and Overview, Prognosis and Outcomes
  2. [2]

    Riyas Mohamed FR, Nisar M, Saeed I et al.. “Incidence, risk factors and outcomes of BCGosis following BCG vaccination in infants: a systematic review and meta-analyses.” Frontiers in immunology (2025). PMID: 41459544 ↗

    L1SR_OBSCited in: Definition and Overview
  3. [3]

    Jackson DJ, Shavit A, Ding N et al.. “Systematic Literature Review of Real-World Outcomes of Benralizumab in Eosinophilic Granulomatosis With Polyangiitis.” The journal of allergy and clinical immunology. In practice (2025). PMID: 40915536 ↗

    L2SR_OBSCited in: Definition and Overview, Prognosis and Outcomes
  4. [4]

    Lazzeroni M, Longoni V, Schiavo P et al.. “Anti-IL5/IL-5 receptor therapies for eosinophilic granulomatosis with polyangiitis: an updated Systematic Review.” Frontiers in immunology (2025). PMID: 40766318 ↗

    L2SR_OBSCited in: Definition and Overview, Pathogenesis and Molecular Mechanisms, Prognosis and Outcomes
  5. [5]

    Foroohar T, Berk-Krauss J, Caplan AS et al.. “Granuloma Annulare: An Updated Review of Epidemiology, Molecular Pathogenesis, and Management.” Journal of the American Academy of Dermatology (2026). PMID: 42320859 ↗

    L5REVIEW_NARRATIVECited in: Definition and Overview
  6. [6]

    Monaco SE, Maleki Z, Rodriguez EF. “Treatment-related changes in cytopathology and small biopsies: an increasing array of morphological findings with expanding therapeutic options.” Journal of the American Society of Cytopathology (2026). PMID: 42091402 ↗

    L5REVIEW_NARRATIVECited in: Definition and Overview
  7. [7]

    Benavides-Villanueva F, Prieto-Peña D, Calvo-Río V et al.. “Epidemiology of eosinophilic granulomatosis with polyangiitis in northern Spain: A population-based study (2000-2024) and literature review.” Autoimmunity reviews (2026). PMID: 41806950 ↗

    L3REVIEW_NARRATIVECited in: Definition and Overview
  8. [8]

    Churg A, Muller NL. “Granulomatosis With Polyangiitis (Wegener Granulomatosis): Then and Now.” Archives of pathology & laboratory medicine (2025). PMID: 41429180 ↗

    L5REVIEW_NARRATIVECited in: Definition and Overview
  9. [9]

    Wang H, Wu D, Lo C et al.. “Foreign Body Granulomas Reaction Related to Collagen Stimulatory Cosmetic Fillers: A Systematic Review.” Journal of cosmetic dermatology (2025). PMID: 41132036 ↗

    L4SR_OBSCited in: Etiology and Causes, Differential Diagnosis
  10. [10]

    Key S, Lee MF, Jiang W et al.. “Non-Tuberculous Laryngeal Granulomas: Systematic Review and Case Series.” ANZ journal of surgery (2025). PMID: 41001724 ↗

    L4SR_OBSCited in: Etiology and Causes, Diagnostic Workup
  11. [11]

    Block B, Mehta J, Soto-Canetti G et al.. “Association Between Type I Interferonopathies and the Development of Cutaneous Sarcoidosis, Morphea, Lichen Planus and Granuloma Annulare: A Retrospective Cohort Study.” Experimental dermatology (2026). PMID: 42266012 ↗

    L3COHORTCited in: Etiology and Causes, Pathogenesis and Molecular Mechanisms
  12. [12]

    Li L, Liu Y, Liu J et al.. “Parathyroid-independent hypercalcemia as initial presentation of renal sarcoidosis with granulomatous interstitial nephritis: a case report.” Frontiers in endocrinology (2026). PMID: 41641029 ↗

    L4CASE_REPORTCited in: Etiology and Causes
  13. [13]

    Pambayi STL, Zhao Z, Peng H et al.. “Inflammatory Pseudotumor After Total Hip Arthroplasty-An Increasingly Recognized Complication.” Orthopaedic surgery (2026). PMID: 42231602 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Causes
  14. [14]

    Vagts C, Ascoli C, Jacobson JR. “Immunopathogenesis of Sarcoidosis.” Seminars in respiratory and critical care medicine (2025). PMID: 41197661 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Causes, Pathogenesis and Molecular Mechanisms
  15. [15]

    Ranjith Singh S, Makatini MM, Marimuthu T et al.. “Advancing Tuberculosis Chemotherapy: Targeted Nanomedicines for the Mycobacterium TB Granuloma.” Small (Weinheim an der Bergstrasse, Germany) (2025). PMID: 41163525 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Causes, Treatment Principles and Management
  16. [16]

    Beig H, Singh A. “Neutrophils from Protection to Pathogenesis in Tuberculosis.” ACS infectious diseases (2025). PMID: 41086419 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Causes
  17. [17]

    Alam M, Caplan AS, Rosenbach M. “When granulomatous inflammation becomes visible: insights into cutaneous sarcoidosis.” Current opinion in immunology (2025). PMID: 41046794 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Causes, Clinical Presentation by Organ System
  18. [18]

    Petrek M, Rivera NV. “From genes to granulomas: the genetic blueprint of sarcoidosis.” Current opinion in immunology (2025). PMID: 40974839 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Causes
  19. [19]

    Zapico D, Espinosa J, Fernández M et al.. “Local assessment of the immunohistochemical expression of Foxp3+ regulatory T lymphocytes in the different pathological forms associated with bovine paratuberculosis.” BMC veterinary research (2022). PMID: 35927759 ↗

    L4RCTCited in: Pathogenesis and Molecular Mechanisms
  20. [20]

    McCaffrey EF, Donato M, Keren L et al.. “The immunoregulatory landscape of human tuberculosis granulomas.” Nature immunology (2022). PMID: 35058616 ↗

    L4SR_OBSCited in: Pathogenesis and Molecular Mechanisms, Key Evidence and Landmark Studies
  21. [21]

    Berti A, Pagnoux C. “Interleukin-5, Eosinophils, and Interleukin-5 Pathway Inhibitors in Eosinophilic Granulomatosis With Polyangiitis.” Arthritis & rheumatology (Hoboken, N.J.) (2026). PMID: 41098028 ↗

    L4CASE_REPORTCited in: Pathogenesis and Molecular Mechanisms
  22. [22]

    Butler DSC. “Re-defining granulomas: bacterial effectors, host circuits, and spatially resolved immunity.” Journal of leukocyte biology (2026). PMID: 41921569 ↗

    L5REVIEW_NARRATIVECited in: Pathogenesis and Molecular Mechanisms
  23. [23]

    Nanzer AM, Terrier B, Wechsler ME. “Treatment of Eosinophilic Granulomatosis With Polyangiitis (EGPA): Do We Need Immunosuppressives?” The journal of allergy and clinical immunology. In practice (2026). PMID: 41616960 ↗

    L5REVIEW_NARRATIVECited in: Pathogenesis and Molecular Mechanisms, Treatment Principles and Management
  24. [24]

    Lyu J, Narum DE, Baldwin SL et al.. “Understanding the development of tuberculous granulomas: insights into host protection and pathogenesis, a review in humans and animals.” Frontiers in immunology (2024). PMID: 39717773 ↗

    L5REVIEW_NARRATIVECited in: Pathogenesis and Molecular Mechanisms
  25. [25]

    Nakamizo S, Kabashima K. “Metabolic reprogramming and macrophage polarization in granuloma formation.” International immunology (2024). PMID: 38441292 ↗

    L5REVIEW_NARRATIVECited in: Pathogenesis and Molecular Mechanisms
  26. [26]

    Athavale A, Thao M, Sassaki VS et al.. “Cyanoacrylate glue reactions: A systematic review, cases, and proposed mechanisms.” Journal of vascular surgery. Venous and lymphatic disorders (2023). PMID: 37054883 ↗

    L4SR_OBSCited in: Morphological Classification of Granulomas
  27. [27]

    Machado RA, Oliveira LQ, Martelli-Júnior H et al.. “Adverse reactions to the injection of face and neck aesthetic filling materials: a systematic review.” Medicina oral, patologia oral y cirugia bucal (2023). PMID: 36565218 ↗

    L4SR_OBSCited in: Morphological Classification of Granulomas
  28. [28]

    Kim H, Cho SH, Lee JD et al.. “Delayed onset filler complication: Two case reports and literature review.” Dermatologic therapy (2017). PMID: 28585321 ↗

    L4CASE_REPORTCited in: Morphological Classification of Granulomas
  29. [29]

    Verbsky JW, Routes JM. “Sarcoidosis and common variable immunodeficiency: similarities and differences.” Seminars in respiratory and critical care medicine (2014). PMID: 25007085 ↗

    L5REVIEW_NARRATIVECited in: Morphological Classification of Granulomas
  30. [30]

    Neerukonda VK, Lefebvre D, Chatson GP et al.. “Silicone Granulomas of the Eyelids-A Case Series Illustrating a Distant Migratory Phenomenon.” Ophthalmic plastic and reconstructive surgery (2022). PMID: 36136734 ↗

    L4CASE_REPORTCited in: Morphological Classification of Granulomas
  31. [31]

    Wulu JA, Garcia-Rodriguez L, Prilutskiy A et al.. “The case of the eyelid silicone granulomas.” American journal of otolaryngology (2019). PMID: 31133360 ↗

    L4CASE_REPORTCited in: Morphological Classification of Granulomas
  32. [32]

    Slater LA, Chandra RV, Holt M et al.. “Long-term MRI findings of muslin-induced foreign body granulomas after aneurysm wrapping. A report of two cases and literature review.” Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences (2014). PMID: 24556302 ↗

    L4CASE_REPORTCited in: Morphological Classification of Granulomas
  33. [33]

    Pang L, Wu S, Kong J. “Hepatic hilar mass in an adolescent: a rare case of hepatobiliary tuberculosis.” BMC infectious diseases (2019). PMID: 30832669 ↗

    L4CASE_REPORTCited in: Morphological Classification of Granulomas
  34. [34]

    Wälscher J, Büscher E, Bonella F et al.. “Comparison of a 22G Crown-Cut Needle with a Conventional 22G Needle with EBUS Guidance in Diagnosis of Sarcoidosis.” Lung (2022). PMID: 36045227 ↗

    L1RCTCited in: Histopathology and Microscopic Features
  35. [35]

    Richardson J, Stanbouly D, Litman E et al.. “Central giant cell granuloma of the head & neck: A case report and systematic review.” Journal of stomatology, oral and maxillofacial surgery (2021). PMID: 34411774 ↗

    L4SR_OBSCited in: Histopathology and Microscopic Features
  36. [36]

    Yao L, Huang D, Jiang Y et al.. “Generalized Actinic Granuloma After Prolonged Heat Exposure Improving With Baricitinib: A Case Report and Review of the Literature.” The Journal of dermatology (2026). PMID: 41761435 ↗

    L4CASE_REPORTCited in: Histopathology and Microscopic Features
  37. [37]

    Zhang X, Li J, Diao X et al.. “Rapidly growing esophageal pyogenic granuloma: A case report and review of the literature.” Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2026). PMID: 41656118 ↗

    L4CASE_REPORTCited in: Histopathology and Microscopic Features
  38. [38]

    Rammal R, Korentzelos D, Skaugen JM et al.. “Molecular Characterization of Malignant Renal Epithelioid Angiomyolipoma: A Review of Two Cases.” American journal of clinical pathology (2023). PMID: 36661215 ↗

    L4CASE_REPORTCited in: Histopathology and Microscopic Features
  39. [39]

    Thompson LDR. “Uncommon Fibroinflammatory Sinonasal Tract Lesions: Granulomatosis with Polyangiitis, Eosinophilic Angiocentric Fibrosis, and Rosai-Dorfman Disease.” Surgical pathology clinics (2024). PMID: 39489548 ↗

    L5REVIEW_NARRATIVECited in: Histopathology and Microscopic Features
  40. [40]

    Ahmed A, Naidu A. “Towards better understanding of giant cell granulomas of the oral cavity.” Journal of clinical pathology (2021). PMID: 33858937 ↗

    L5REVIEW_NARRATIVECited in: Histopathology and Microscopic Features
  41. [41]

    Sarkar S, Mandal S, Ayyanar P et al.. “Epithelioid Trophoblastic Tumor Predominant Mixed Germ Cell Tumor of the Testis: A Case Report and Review of the Literature.” International journal of surgical pathology (2024). PMID: 39295456 ↗

    L4CASE_REPORTCited in: Histopathology and Microscopic Features
  42. [42]

    Shah N, Shah M, Drucker AM et al.. “Granulomatous Cutaneous Drug Eruptions: A Systematic Review.” American journal of clinical dermatology (2021). PMID: 33108647 ↗

    L4SR_OBSCited in: Clinical Presentation by Organ System
  43. [43]

    Nguyen H, Pham DH, Luong TH. “Successful surgical management of an aggressive IgG4-related sclerosing esophageal inflammatory pseudotumor: a case report and review of literature.” Journal of cardiothoracic surgery (2023). PMID: 37403075 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System, Diagnostic Workup
  44. [44]

    Ghazi TU, Sioshansi PC, Hong RS. “Post-stapedotomy reparative granuloma following use of acellular porcine small intestinal submucosa.” American journal of otolaryngology (2021). PMID: 33545450 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  45. [45]

    Fang Y, Cheng L, Guo J et al.. “Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review.” Journal of cardiothoracic surgery (2020). PMID: 33225977 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  46. [46]

    Wang W, Zhao D, Ren R et al.. “Case Report: Serum IgG4-negative multifocal IgG4-related hepatic inflammatory pseudotumor: dissociation between circulating IgG4 and local immune activation.” Frontiers in immunology (2026). PMID: 42064069 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  47. [47]

    Yamate T, Goto M, Nishida H et al.. “Erythroderma-Like Manifestations and High Fever in Palisaded Neutrophilic and Granulomatous Dermatitis Without Any Underlying Systemic Immunological Disease.” The Journal of dermatology (2026). PMID: 41795692 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  48. [48]

    Wang W, Li W, Zhang T et al.. “Case Report: Regenerative hepatic pseudotumor induced by tislelizumab in a lung cancer patient.” Frontiers in immunology (2025). PMID: 40519910 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  49. [49]

    Wang P, Liu XD, Li B et al.. “Primary tuberculous granuloma in the falciform ligament of liver.” Liver international : official journal of the International Association for the Study of the Liver (2022). PMID: 35246925 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  50. [50]

    Chrysikos S, Papaioannou O, Anyfanti M et al.. “A 52-Year-Old Man Presented With Cough, Chest Pain, and a Mass in the Right Lung.” Chest (2020). PMID: 33160545 ↗

    L4CASE_REPORTCited in: Clinical Presentation by Organ System
  51. [51]

    Wang X, Liu FJ, Chen CL et al.. “Retrospective Study on Palpable Indurations After Cosmetic Filler Injection: Ultrasonic Characterization and Image-Guided Therapy.” Aesthetic surgery journal (2026). PMID: 41968101 ↗

    L4COHORTCited in: Diagnostic Workup, Prognosis and Outcomes
  52. [52]

    Rezende KM, de Barros Gallo C, Nogueira GP et al.. “Retrospective study of oral lesions biopsied in babies and toddlers.” Oral diseases (2023). PMID: 36825395 ↗

    L4COHORTCited in: Diagnostic Workup
  53. [53]

    Mironova M, Gopalakrishna H, Rodriguez Franco G et al.. “Granulomatous liver diseases.” Hepatology communications (2024). PMID: 38497932 ↗

    L5REVIEW_NARRATIVECited in: Diagnostic Workup
  54. [54]

    Maccio U, Gianolio A, Rets AV. “Granulomas in bone marrow biopsies: clinicopathological significance and new perspectives.” Journal of clinical pathology (2023). PMID: 37640519 ↗

    L5REVIEW_NARRATIVECited in: Diagnostic Workup
  55. [55]

    Shen J, Lackey E, Shah S. “Neurosarcoidosis: Diagnostic Challenges and Mimics A Review.” Current allergy and asthma reports (2023). PMID: 37256482 ↗

    L5REVIEW_NARRATIVECited in: Diagnostic Workup
  56. [56]

    Zhongkai W, Ruijie L, Liping L et al.. “Abdominal pain as the sole initial manifestation of ANCA-positive EGPA with myocarditis: a case report and literature review.” BMC cardiovascular disorders (2025). PMID: 41299254 ↗

    L4CASE_REPORTCited in: Diagnostic Workup
  57. [57]

    Gong M, Kim MJ, Han SY et al.. “Two typical and one atypical presentation of TUGSE: Case series and literature review.” Journal of stomatology, oral and maxillofacial surgery (2025). PMID: 40796054 ↗

    L4CASE_REPORTCited in: Diagnostic Workup
  58. [58]

    Mancianti N, Guarnieri A, Donati G et al.. “From Guillain-Barré-Like Neuropathy to EGPA: ANCA Testing and Kidney Biopsy as Diagnostic Turning Points.” Nephrology (Carlton, Vic.) (2026). PMID: 42115108 ↗

    L4CASE_REPORTCited in: Diagnostic Workup
  59. [59]

    Easterling R, James WE. “Overlap syndromes in sarcoidosis: Unveiling the masquerader.” Respiratory medicine (2024). PMID: 39433108 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  60. [60]

    Xu X, Song K, Shen Y et al.. “Foreign Body Granuloma and Infection-Related Complications Arising From Acupoint Embedding: A Case Study and Literature Review.” Journal of cosmetic dermatology (2026). PMID: 41664559 ↗

    L5CASE_REPORTCited in: Differential Diagnosis
  61. [61]

    Lee DH, Moon JK. “Xanthogranulomatous osteomyelitis of pubic bone mimicking neoplasm: a case report and literature review.” BMC musculoskeletal disorders (2024). PMID: 39354510 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  62. [62]

    Gros C, Hankiewicz K, Carle A et al.. “Case Report: Necrotizing granulomas in the central nervous system: sarcoidosis masquerading as neurotuberculosis.” Frontiers in immunology (2025). PMID: 41246339 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  63. [63]

    Aboseif A, Taha F, Tagg NT et al.. “Effectiveness of Infliximab for Refractory Nonischemic Cerebral Enhancing Foreign-Body Granulomatous Lesions After Endovascular Therapy.” Neurology (2025). PMID: 41160790 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  64. [64]

    Sarli WM, Quaranta F, Canessa C et al.. “Uncovering hidden immune defects in childhood granulomatous disorders: a case report.” Frontiers in immunology (2025). PMID: 40755768 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  65. [65]

    Zhou Z, Hu X, Wang J et al.. “Invasive cerebral aspergillosis in a pregnant woman: a rare case of intracranial giant granuloma.” BMC infectious diseases (2025). PMID: 40200155 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  66. [66]

    Merkel PA, Nair PK, Khalidi N et al.. “Two-year efficacy and safety of anti-interleukin-5/receptor therapy for eosinophilic granulomatosis with polyangiitis.” Annals of the rheumatic diseases (2025). PMID: 40781045 ↗

    L1RCTCited in: Treatment Principles and Management
  67. [67]

    Spataro F, Solimando AG, Di Girolamo A et al.. “Efficacy and safety of benralizumab in eosinophilic granulomatosis with polyangiitis: A meta-analysis of eight studies.” European journal of clinical investigation (2024). PMID: 39387173 ↗

    L1SR_OBSCited in: Treatment Principles and Management
  68. [68]

    Lapidus AH, Lee S, Khandewal T et al.. “Subcutaneous granuloma annulare: a systematic review of a rare and underdiagnosed disease.” International journal of dermatology (2024). PMID: 39090834 ↗

    L5SR_OBSCited in: Treatment Principles and Management
  69. [69]

    Bettolini L, Maione V, Carugno A et al.. “Management Strategies for Generalised Granuloma Annulare: A Systematic Review of Current and Emerging Therapies.” The Australasian journal of dermatology (2025). PMID: 40586485 ↗

    L5SR_OBSCited in: Treatment Principles and Management
  70. [70]

    Dereseviciene G, Gumbis G, Miltiniene D et al.. “Epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis in Lithuania, 2012-2021: a retrospective cohort study.” BMJ open (2025). PMID: 41263843 ↗

    L2COHORTCited in: Treatment Principles and Management, Prognosis and Outcomes
  71. [71]

    Yang Y, Zhang X, Zhong Q et al.. “Clinical heterogeneity and prognostic markers in head and neck Kimura disease: A retrospective study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40926047 ↗

    L4COHORTCited in: Treatment Principles and Management, Prognosis and Outcomes
  72. [72]

    Blanco R, Rua-Figueroa Í, Blanco-Aparicio M et al.. “Expert review and recommendations on the diagnosis and therapeutic management of eosinophilic granulomatosis with polyangiitis.” Frontiers in immunology (2026). PMID: 42051495 ↗

    L5REVIEW_NARRATIVECited in: Treatment Principles and Management
  73. [73]

    Tamaki H. “Current definition of remission in eosinophilic granulomatosis with polyangiitis (EGPA) and future perspectives.” Allergology international : official journal of the Japanese Society of Allergology (2025). PMID: 41233277 ↗

    L5REVIEW_NARRATIVECited in: Treatment Principles and Management
  74. [74]

    Hoshino M, Sakata K, Kajiwara S et al.. “Long-term efficacy of endoscopic endonasal transsphenoidal marsupialization using a nasoseptal mucosal flap for petrous apex cholesterol granuloma: systematic review and two case reports.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 41521199 ↗

    L5SR_OBSCited in: Prognosis and Outcomes
  75. [75]

    Codirenzi M, Davanzo F, Iorio L et al.. “Comparative real-world effectiveness and safety of benralizumab and two mepolizumab dosing regimens in eosinophilic granulomatosis with polyangiitis: a 24-month prospective single-center cohort study.” Frontiers in immunology (2026). PMID: 42375373 ↗

    L2COHORTCited in: Prognosis and Outcomes
  76. [76]

    Wang H, Jiang HY, Zhang YX et al.. “Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials.” Stem cell research & therapy (2023). PMID: 37101285 ↗

    L1TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  77. [77]

    Le Roux K, Streichenberger N, Vial C et al.. “Granulomatous myositis: a clinical study of thirteen cases.” Muscle & nerve (2007). PMID: 17068767 ↗

    L4TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  78. [78]

    de Bie CI, Paerregaard A, Kolacek S et al.. “Disease phenotype at diagnosis in pediatric Crohn's disease: 5-year analyses of the EUROKIDS Registry.” Inflammatory bowel diseases (2013). PMID: 22573581 ↗

    L2TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  79. [79]

    Fritscher-Ravens A, Ghanbari A, Topalidis T et al.. “Granulomatous mediastinal adenopathy: can endoscopic ultrasound-guided fine-needle aspiration differentiate between tuberculosis and sarcoidosis?” Endoscopy (2011). PMID: 21833904 ↗

    L2TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  80. [80]

    Teskey G, Cao R, Islamoglu H et al.. “The Synergistic Effects of the Glutathione Precursor, NAC and First-Line Antibiotics in the Granulomatous Response Against Mycobacterium tuberculosis.” Frontiers in immunology (2018). PMID: 30258443 ↗

    L5TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  81. [81]

    Smith AM, Sewell GW, Levine AP et al.. “Disruption of macrophage pro-inflammatory cytokine release in Crohn's disease is associated with reduced optineurin expression in a subset of patients.” Immunology (2015). PMID: 24943399 ↗

    L3TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  82. [82]

    Iwashita T, Yasuda I, Tsurumi H et al.. “Endoscopic ultrasound-guided fine needle aspiration biopsy for splenic tumor: a case series.” Endoscopy (2009). PMID: 19214901 ↗

    L4TRIAL_NONRANDOMCited in: Key Evidence and Landmark Studies
  83. [83]

    Limsrivilai J, Shreiner AB, Pongpaibul A et al.. “Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease.” The American journal of gastroenterology (2017). PMID: 28045023 ↗

    L1SR_OBSCited in: Key Evidence and Landmark Studies
  84. [84]

    Hong SW, Yoon H, Shin CM et al.. “Clinical significance of granulomas in Crohn's disease: A systematic review and meta-analysis.” Journal of gastroenterology and hepatology (2019). PMID: 31522456 ↗

    L2SR_OBSCited in: Key Evidence and Landmark Studies
  85. [85]

    Ooi CJ, Ling KL, Limsrivilai J et al.. “Asian Pacific Association of Gastroenterology (APAGE) Clinical Practice Guidelines on the Use of Small Molecules and IL-23 p19 Inhibitors in Ulcerative Colitis and Crohn's Disease.” Journal of gastroenterology and hepatology (2026). PMID: 42117726 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  86. [86]

    Scott FI, Ananthakrishnan AN, Click B et al.. “AGA Living Clinical Practice Guideline on the Pharmacologic Management of Moderate-to-Severe Crohn's Disease.” Gastroenterology (2025). PMID: 41274746 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  87. [87]

    Blauvelt A, Strober BE, Eakin GS et al.. “Joint position statement from the National Psoriasis Foundation Medical Board and the International Psoriasis Council on routine testing for latent tuberculosis infection prior to and during treatment of psoriasis patients with interleukin 17 or interleukin 23 inhibitors.” Journal of the American Academy of Dermatology (2025). PMID: 41260526 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  88. [88]

    Donovan J, Cresswell FV, Tucker EW et al.. “A clinical practice guideline for tuberculous meningitis.” The Lancet. Infectious diseases (2025). PMID: 40840485 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  89. [89]

    Lichtenstein GR, Loftus EV, Afzali A et al.. “ACG Clinical Guideline: Management of Crohn's Disease in Adults.” The American journal of gastroenterology (2025). PMID: 40701562 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  90. [90]

    Saukkonen JJ, Duarte R, Munsiff SS et al.. “Updates on the Treatment of Drug-Susceptible and Drug-Resistant Tuberculosis: An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline.” American journal of respiratory and critical care medicine (2025). PMID: 40693952 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  91. [91]

    Hameed M, De Kock I, Stoker J et al.. “ESR Essentials: diagnosis and assessment of treatment response in patients with luminal Crohn's disease-practice recommendations by the European Society of Gastrointestinal and Abdominal Radiology.” European radiology (2025). PMID: 40500529 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements
  92. [92]

    Alhusayen R, Dienes S, Lam M et al.. “North American clinical practice guidelines for the medical management of hidradenitis suppurativa in special patient populations.” Journal of the American Academy of Dermatology (2024). PMID: 39725212 ↗

    L1GUIDELINECited in: Guidelines and Consensus Statements

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