| SKIN: Granulomatous lesions
Nodular Dermatitis, Histiocytes Predominant:
- lichen nitidus.
- no evidence of foreign body:
evidence of foreign body:
- Crohn's disease.
- Melkersson-Rosenthal syndrome (cheilitis granulomatosa Miescher Melkerson Rosenthal).
peri-infundibular: granulomatous rosacea.
pseudolymphoma with focal granuloma component HERE.
perineural: tracking S100-positive nerve twigs [S08-16360 & CN08-48], suggests tuberculoid & dimorphous leprosy (but can't be "diagnosed" unless actually see organisms by stain), but sarcoid can also do it.
- silica granuloma.
- tatto material (such as mercury, cobalt).
- no foreign body & infectious:
- no foreign body & noninfectious:
- foreign body:
- degenerated collagen early, coarse bundles late
- degenerated collagen, cholesterol clefts, lipophages
- ghost of venule in center & epithelioid histiocytes sometiomes in the periphery in a palisade (Churg-Strauss granuloma).
- fibrin: rheumatoid nodule.
- urate deposits: gout.
- vasculitis, fibrin, necrosis of inflammatory cells: papulonecrotic tuberculid.
- collagen bundles different from normal human ones: Zyderm (bovine) collagen reaction.
- mucin: granuloma annulare (GA).
- degenerated collagen plus mixed cell infiltrate: interstitial granulomatous dermatitis with arthritis.
- no infectious agent identifiable:
infectious agent identifiable:
- squames: ruptured millium, infundibular, or isthmic cyst.
- foreign material: metals, tattoo (mercury, cobalt), splinter, suture, cactus spine, silica, starch, drug injection, Talwin.
- bacterial: botryomycosis (sulfur granules; bacterial); blastomycosis-like pyoderma (bacterial & vegetative), HERE; rhinoscleroma (bacterial), HERE; cat scratch disease (bacterial & lymph node necrosis foci as rods & cocci by Warthin-Starry silver & confirm with Brown-Hopps Gram stain showing as very thin Gram neg. rods3); lymphogranuloma venereum (LGV; due to chlamydia).
- mycobacterial: scrofuloderma, atypical mycobacterial infection, leprosy [S09-16360] (expert mycobacterial testing at ADL in National Jewish Hospital, Denver, Colorado).
- fungal, deep:
- fungal, other than deep:
- 3/24/10 expert consult from Dr. David Scollard @ National Hansen's Disease Programs, Baton Rouge, LA.
- Decision tree for leprosy [HERE] & other mycobacterial testing at ADL, above, or check with University of Washington molecular microbiology lab in Seattle.
- Carter JB, et. al., AJSP, p276, 1986, HERE.
- Chart after Ackerman BA.
(posted 29 December 2008; latest adjustment 24 May 2015)
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