What Are the 4 Granulomatous Diseases?

Granulomas Uncovered: What They Mean and When to Act

A granuloma is a group of immune cells the body forms when attempting to wall off infections or chronic inflammation that it cannot eliminate. These are commonly seen in 4 major diseases.

Although distinct, all these diseases produce the body's exact defence mechanism, forming granulomas. Therefore, it is crucial to understand what a granuloma is and what diseases are associated with it for timely detection and proper treatment.

Keep reading to learn more about granuloma diseases. 

What is a Granuloma?

A granuloma is an area of localised inflammation that forms when the immune system walls off substances it perceives as harmful but cannot eliminate. These are clusters of white blood cells gathered around bacteria, foreign objects, or irritants.

Granulomas tend to develop most frequently in the lungs and in the liver, kidneys, skin, or other tissues.

What are the 4 common diseases associated with granuloma formation?

Granulomas represent a significant immune reaction in many conditions. 4 of the most critical diseases where granuloma formation is essential are as follows:

1. Tuberculosis

Tuberculosis is a major infectious disease risk factor globally. It's caused by Mycobacterium tuberculosis, which lives inside the immune cells (macrophages). Once the bacteria are in the lungs, the immune system creates granulomas, or Ghon foci, to encase the infection.

Usually, the granulomas capture the bacteria and keep them contained. However, if a person has a compromised immune system, the infection can spread from the lungs and become systemic. Even if the bacteria do not spread, they can reactivate and cause active disease later.

2. Sarcoidosis

Sarcoidosis is an organ disease that leads to the development of noncaseating granulomas (granulomas without evidence of tissue necrosis). The reason is unknown, but specialists believe that an airborne pathogen that cannot be cleared by the immune system could be the cause.

Although 95% of the patients have lung and chest lymph node involvement, granulomas can also develop in the skin, liver, eyes, and lymph nodes. Despite three decades of research, the antigen responsible for this reaction is still not known.

3. Crohn's Disease

Crohn's is a long-term condition that causes inflammation of the gastrointestinal tract. One of its most characteristic microscopic findings is the formation of non-necrotising granulomas within the intestinal tissue, though not everyone with Crohn's has them.

If granulomas do form, they are helpful in diagnosing Crohn's disease and differentiating it from other illnesses, such as ulcerative colitis. Research also indicates that patients who do have granulomas can develop an even more serious manifestation of Crohn's disease.

4. Granulomatosis with Polyangiitis

Granulomatosis with polyangiitis (GPA), or Wegener's granulomatosis, is a rare autoimmune disease. GPA typically features granulomas, but biopsy sampling limitations may occasionally miss them. Additional findings (e.g., vasculitis, necrosis) aid diagnosis.

What Causes Granulomas?

Granulomas form when macrophages fail to eliminate pathogens or foreign material, or due to dysregulated immune responses (e.g., autoimmune or idiopathic causes). It may be an infection (such as bacteria or fungus) or something foreign to your body (such as stitches or a splinter piece in your skin).

Macrophages are unique immune cells that "eat" things that should not be in your body and destroy them. If they cannot eliminate something, more immune cells move into the area, packing themselves tightly into a clump of cells.

Granulomas may also develop when the immune system overreacts and becomes inflamed, but there is no infection to fight. That is typical of some autoimmune disorders.

What Infections Lead to Granulomas?

While tuberculosis is the most common infectious trigger for granuloma formation, these cellular clusters can also result from other bacterial infections, fungal infections, parasites, and certain viruses, including:

• Aspergillosis
• Blastomycosis
• Candidiasis
• Cat scratch disease
• Coccidioidomycosis (valley fever)
• Cytomegalovirus
• Dirofilariasis
• Epstein-Barr virus
• Histoplasmosis
• Leishmaniasis
• Leprosy (Hansen's disease)
• Measles
• Mycobacterium marinum (fish tank granuloma)
• Schistosomiasis

How Are Granulomas Treated?

Treatment is provided depending on the cause and type of granuloma. Some require no medical care at all. Listed below are the treatment options as per the condition:

• Sarcoidosis: Half of all cases resolve spontaneously without treatment within a couple of years.
• Granuloma Annulare: It often resolves on its own. If desired for cosmetic reasons, treatment may include corticosteroid creams or light therapy.
• Pyogenic Granuloma: Typically requires removal. The most common approach involves surgical removal followed by bleeding control.

Is Granulomatous Disease Curable?

There is no permanent cure for chronic granulomatous disease (CGD), but stem cell treatment can provide hope to some patients. With proper care, the symptoms can be managed, and infection can be avoided or reduced.

Granulomas are a standard body defence mechanism. They tend to present as small lumps in the lung or as bumps on the skin, particularly around foreign bodies. They usually do not need treatment and may simply resolve spontaneously after a while.

However, if you have ongoing health illnesses such as sarcoidosis or an autoimmune disorder, you are more likely to develop more granulomas. Ensure you consult your doctor if you develop new or repeated symptoms, since there may be ways to manage your illness more effectively.

Also, having a health insurance policy can be critical to safeguarding your finances in a medical crisis. Star Health provides whole health care coverage under its general insurance policies with cashless claims and hassle-free treatment in more than 14,000 network hospitals across India. With proper assistance, you can tackle health issues calmly with financial safety.

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