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. 2017 Aug 25;34(2):200–207. doi: 10.36141/svdld.v34i2.5674

Mnemonic for the differential diagnosis of non-caseating granulomas

Atul C Mehta 1,, Syed Rizwan Ali 2
PMCID: PMC7170149  PMID: 32476846

Additional material

Appendix 1

4. Marchevsky A, Damsker B, Gribetz A, Tepper S, Geller SA. The spectrum of pathology of nontuberculous mycobacterial infections in open-lung biopsy specimens. Am J Clin Pathol. 1982;78(5):695-700. Epub 1982/11/01. PubMed PMID: 7137111.

5. Dumouchel-Champagne H, Charlier-Woerther C, Boibieux A, Ffrench M, Carret G, Chidiac C, et al. Disseminated nontuberculous infections with Mycobacterium genavense during sarcoidosis. European Respiratory Review. 2009;18(114):299-301.

6. Mortaz E, Adcock IM, Barnes PJ. Sarcoidosis: Role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis. International journal of mycobacteriology. 2014;3(4):225-9.

7. Ioachimescu OC, Tomford JW. Nontuberculous mycobacterial disorders. Disease Management Project. 2015.

8. Bretza J, Mayfield JD. Mycobacterium intracellulare presenting as a sarcoid-like illness. South Med J. 1978;71(7):872-4. Epub 1978/07/01. PubMed PMID: 663741.

9. Infante PF, Newman LS. Beryllium exposure and chronic beryllium disease. The Lancet. 2004;363(9407):415-6.

10. Stoeckle JD, Hardy HL, Weber AL. Chronic beryllium disease: long-term follow-up of sixty cases and selective review of the literature. The American journal of medicine. 1969;46(4):545-61.

11. Williams WJ. The beryllium granuloma. Proceedings of the Royal Society of Medicine. 1971;64(9):946-8. PubMed PMID: PMC1812799.

12. Pavic M, Debourdeau P, Vacelet V, Rousset H. [Sarcoidosis and sarcoid reactions in cancer]. Rev Med Interne. 2008;29(1):39-45. Epub 2007/12/07. doi: 10.1016/j.revmed.2007.09.041. PubMed PMID: 18054124.

13. Fujii T, Tabe Y, Yajima R, Tsutsumi S, Asao T, Kuwano H. Adenocarcinoma of Ascending Colon Associated with Sarcoid Reaction in Regional Lymph Nodes. Case Reports in Gastroenterology. 2010;4(1):118-23. doi: 10.1159/000275064. PubMed PMID: PMC2988908.

14. Butt S, Alzebdeh R, Kable TD, Soubani AO. Non-caseating granulomas in patients after the diagnosis of cancer: clinical characteristics and outcome. Sarcoidosis Vasc Diffuse Lung Dis. 2011;28(1):44-9. Epub 2011/07/30. PubMed PMID: 21796890.

15. Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev. 1986;13(3):147-56. Epub 1986/09/01. PubMed PMID: 3536088.

16. Swank LA, Chejfec G, Nemchausky BA. Allopurinol-induced granulomatous hepatitis with cholangitis and a sarcoid-like reaction. Arch Intern Med. 1978;138(6):997-8. Epub 1978/06/01. PubMed PMID: 646570.

17. Bhargava S, Perlman DM, Allen TL, Ritter JH, Bhargava M. Adalimumab induced pulmonary sarcoid reaction. Respir Med Case Rep. 2013;10:53-5. Epub 2013/01/01. doi: 10.1016/j.rmcr.2013.07.002. PubMed PMID: 26029514; PubMed Central PMCID: PMCPMC3920421.

18. Daien CI, Monnier A, Claudepierre P, Constantin A, Eschard JP, Houvenagel E, et al. Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases. Rheumatology (Oxford). 2009;48(8):883-6. Epub 2009/05/09. doi: 10.1093/rheumatology/kep046. PubMed PMID: 19423648.

19. Choi JH, Shin JA, Park HK, Kim SY, Jung H, Lee SS, et al. Sarcoidosis associated with oxaliplatin-based chemotherapy for colorectal cancer. Case Rep Oncol Med. 2014;2014:203027. Epub 2014/04/10. doi: 10.1155/2014/203027. PubMed PMID: 24716039; PubMed Central PMCID: PMCPMC3970254.

20. Mistry N, Shapero J, Crawford RI. A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin. Can J Gastroenterol. 2009;23(10):677-83. Epub 2009/10/15. PubMed PMID: 19826642; PubMed Central PMCID: PMCPMC2776610.

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To the Editor:

Sarcoidosis is an elusive disease. It was named so because it was thought to mimic sarcoma (sarcoid -sarcoma-like) when first described in skin lesions (1). It is defined as a systemic granulomatous disease of unknown etiology that primarily affects the lung and lymphatic system of the body. The adjusted annual incidence of sarcoidosis among African Americans is roughly three times that among Caucasian Americans (35.5 vs 10.9 cases/100,000) with a lifetime risk in blacks in the United States of 2.4% as compared to 0.85% in whites (2). A diagnosis of the disorder is made using clinical and radiological findings supported by histological evidence of non-caseating, epithelioid - cell granulomas in more than one organ system and exclusion of other disorders known to cause similar pathology (3). For this purpose, we present a mnemonic to remember most common causes of systemic non-caseating granulomas in form of letters of the alphabet (Table 1). This is aimed at physicians dealing with the condition of Sarcoidosis. References for each diagnosis is presented in the online supplement as Appendix 1.

Table 1.

Mnemonic for causes of non-caseating granulomas

graphic file with name SVDLD-34-200-g001.jpg

Sarcoidosis remains a diagnosis of exclusion. The authors would like to point out that once the presence of non-caseating granulomas has been documented, above conditions should be ruled out before the diagnosis of Sarcoidosis can be confirmed.

References

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Additional material

Appendix 1

4. Marchevsky A, Damsker B, Gribetz A, Tepper S, Geller SA. The spectrum of pathology of nontuberculous mycobacterial infections in open-lung biopsy specimens. Am J Clin Pathol. 1982;78(5):695-700. Epub 1982/11/01. PubMed PMID: 7137111.

5. Dumouchel-Champagne H, Charlier-Woerther C, Boibieux A, Ffrench M, Carret G, Chidiac C, et al. Disseminated nontuberculous infections with Mycobacterium genavense during sarcoidosis. European Respiratory Review. 2009;18(114):299-301.

6. Mortaz E, Adcock IM, Barnes PJ. Sarcoidosis: Role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis. International journal of mycobacteriology. 2014;3(4):225-9.

7. Ioachimescu OC, Tomford JW. Nontuberculous mycobacterial disorders. Disease Management Project. 2015.

8. Bretza J, Mayfield JD. Mycobacterium intracellulare presenting as a sarcoid-like illness. South Med J. 1978;71(7):872-4. Epub 1978/07/01. PubMed PMID: 663741.

9. Infante PF, Newman LS. Beryllium exposure and chronic beryllium disease. The Lancet. 2004;363(9407):415-6.

10. Stoeckle JD, Hardy HL, Weber AL. Chronic beryllium disease: long-term follow-up of sixty cases and selective review of the literature. The American journal of medicine. 1969;46(4):545-61.

11. Williams WJ. The beryllium granuloma. Proceedings of the Royal Society of Medicine. 1971;64(9):946-8. PubMed PMID: PMC1812799.

12. Pavic M, Debourdeau P, Vacelet V, Rousset H. [Sarcoidosis and sarcoid reactions in cancer]. Rev Med Interne. 2008;29(1):39-45. Epub 2007/12/07. doi: 10.1016/j.revmed.2007.09.041. PubMed PMID: 18054124.

13. Fujii T, Tabe Y, Yajima R, Tsutsumi S, Asao T, Kuwano H. Adenocarcinoma of Ascending Colon Associated with Sarcoid Reaction in Regional Lymph Nodes. Case Reports in Gastroenterology. 2010;4(1):118-23. doi: 10.1159/000275064. PubMed PMID: PMC2988908.

14. Butt S, Alzebdeh R, Kable TD, Soubani AO. Non-caseating granulomas in patients after the diagnosis of cancer: clinical characteristics and outcome. Sarcoidosis Vasc Diffuse Lung Dis. 2011;28(1):44-9. Epub 2011/07/30. PubMed PMID: 21796890.

15. Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev. 1986;13(3):147-56. Epub 1986/09/01. PubMed PMID: 3536088.

16. Swank LA, Chejfec G, Nemchausky BA. Allopurinol-induced granulomatous hepatitis with cholangitis and a sarcoid-like reaction. Arch Intern Med. 1978;138(6):997-8. Epub 1978/06/01. PubMed PMID: 646570.

17. Bhargava S, Perlman DM, Allen TL, Ritter JH, Bhargava M. Adalimumab induced pulmonary sarcoid reaction. Respir Med Case Rep. 2013;10:53-5. Epub 2013/01/01. doi: 10.1016/j.rmcr.2013.07.002. PubMed PMID: 26029514; PubMed Central PMCID: PMCPMC3920421.

18. Daien CI, Monnier A, Claudepierre P, Constantin A, Eschard JP, Houvenagel E, et al. Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases. Rheumatology (Oxford). 2009;48(8):883-6. Epub 2009/05/09. doi: 10.1093/rheumatology/kep046. PubMed PMID: 19423648.

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