Table 1.
Typhoid granuloma: a brief review of the literature.
| Author, year, Reference | Number of cases (n) | Age (years)/gender | Site | Pathology | Microbiology | Remarks |
|---|---|---|---|---|---|---|
| Shin et al. [3], 2004 | 16 | 20–56, male : female = 7 : 8 |
Bone marrow | 8/16: chronic granulomatous inflammation (4: well-formed, 4: ill-formed) 4/16: HLH 4/16: reactive marrow 2/16: myeloid hyperplasia 2/16: nonspecific Erythrophagocytosis + Phagocytosis of the debris + |
Salmonella typhi
Culture proven (100%) |
Early phase: myeloid hyperplasia Proliferative phase-histiocytic hyperplasia, granulomas, and erythrophagocytosis + Lysis phase: well-formed granulomas with erythrophagocytosis +. |
|
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| Young et al. [4], 1986 | 60 | 10–60 | Bone marrow | Typhoid cells: 50.8% in BMA; 8/49: granulomas on BMBx (4/8: typhoid cells +) Type of BMG: 6/8: mature histiocytic granuloma, 2/8: epithelioid granuloma Granuloma number: One in 4, two in 3, and four in one |
Salmonella typhi
34/60: bacteriologically proven; 10/60: serologically proven; 16/60: clinically suspected |
No specific morphology of BMG, BMA culture: high yield |
|
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| Lee et al. [5], 1985 | 27 | — | Bone marrow | Well-formed granuloma (57%), ill formed granuloma (43%) Phagocytosis of nuclear debris, RBCs; ++. No caseation or Langhans giant cells |
Salmonella typhi
Culture proven (100%) |
Histiocytic phagocytosis, absence of necrosis and Langhans giant cells, clue to diagnosis of typhoid granulomas |
|
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| Sakhalkar et al. [6], 2001 | 1 | 2, child with Down syndrome | Bone marrow | Fever, pancytopenia, hepatomegaly, hemophagocytosis, BMG |
Salmonella typhi
Culture (BMA and blood) |
EBV positive, Salmonella typhi + |
|
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| Mert et al. [7], 2004 | 2 | 55, females | Liver and spleen | BMA, NAD Noncaseating granulomas |
Salmonella typhi
(blood) |
1st case of typhoid splenic granuloma in the English literature. |
| 66, males | Bone marrow and liver | 2 granulomas in BMBx (noncaseating) 1 microgranuloma in portal region |
Salmonella typhi
Serology Culture (blood, BMA) |
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| Lee et al. [8], 2004 | 1 | 34, males | Bone marrow | Focal epithelioid granuloma Necrotic debris, phagocytosis not seen |
Salmonella paratyphi A Culture (blood and BMA) Serology (typhi H); + (1 : 320) | — |
|
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| Bharadwaj et al. [9], 2009 | 1 | 47, males | Terminal ileum, mesenteric lymph node | Necrotizing and nonnecrotizing epithelioid granulomas, giant cells present Lymphoerythrophagocytosis + (occasional) |
Salmonella typhi
Serology |
— |
|
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| Present case 2013 | 1 | 24, male | Bone marrow | Well-formed noncaseating granulomas (histiocytic and epithelioid type) Erythrophagocytosis ++ |
Salmonella typhi
Serology Culture (BMA, blood) |
Erythrophagocytosis is a clue to the diagnosis of typhoid granulomas |
HLH: hemophagocytic lymphohistiocytosis, +: present, BMA: bone marrow aspiration, BMBx: bone marrow trephine biopsy, BMG: bone marrow granuloma, EBV: Epstein-Barr virus; NAD: no abnormality detected.