granulomatöz

Granulomatöz is a German adjective meaning “granulomatous” and is used to describe diseases, lesions, or histological findings involving granuloma formation. Granulomas are organized collections of macrophages, sometimes fused into epithelioid cells, that appear in response to a persistent irritant, foreign material, or pathogen.

In medicine, granulomatous processes are grouped into infectious and non‑infectious categories. Infectious causes include Mycobacterium tuberculosis, Mycobacterium leprae, Histoplasma capsulatum, and Yersinia pestis. Non‑infectious granulomatous diseases encompass sarcoidosis, Crohn disease, Blau syndrome, and certain drug reactions. Each entity is distinguished by clinical presentation, laboratory findings and, when necessary, histopathologic characteristics.

The hallmark histologic appearance is a well‑defined aggregate of epithelioid cells, often surrounded by lymphocytes and fibroblasts. Caseating necrosis is typical of tuberculous granulomas, whereas non‑caseating granulomas are common in sarcoidosis and Crohn disease. Staining techniques—Ziehl–Neelsen for acid‑fast bacteria, PAS for fungi—as well as cultures and molecular methods aid in identifying infectious agents.

Diagnosis begins with a careful history, physical examination and laboratory tests. Imaging such as chest X‑ray or CT can reveal characteristic patterns (e.g., bilateral hilar lymphadenopathy in sarcoidosis). Histologic confirmation is usually obtained via biopsy of affected tissue or lymph nodes. Once a granulomatous etiology is established, treatment is directed at the underlying cause: antimicrobials for tuberculosis, corticosteroids for sarcoidosis, and immunosuppressive agents for inflammatory bowel disease.

Monitoring of therapy focuses on symptomatic improvement, radiologic regression, and laboratory normalization. In some cases, granulomatous inflammation resolves spontaneously, whereas in others it may progress to chronic fibrosis if untreated.