Caseating Granulomas

[BlackNDecker]

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Goljan says you only find them in Mycobaterial infections and systemic fungal infections...

Qbank says Brucella abortus can cause caseating granulomas 😕

If a question on the step asks about a pt with malaise, chills fatigue, weakness, and ab pain. Biopsy of colon shows caseating granulomas...most likely cause?

If M. bovis and B. abortus are both listed, would you not choose M. bovis? Even if history reveals living on a farm with cows?

Disclaimer: the Qbank question was a gimme, and did NOT include M. bovis.

 

[remedios]

Goljan says you only find them in Mycobaterial infections and systemic fungal infections...

Qbank says Brucella abortus can cause caseating granulomas 😕

If a question on the step asks about a pt with malaise, chills fatigue, weakness, and ab pain. Biopsy of colon shows caseating granulomas...most likely cause?

If M. bovis and B. abortus are both listed, would you not choose M. bovis? Even if history reveals living on a farm with cows?

Disclaimer: the Qbank question was a gimme, and did NOT include M. bovis.

Wasn't that the NEJM case from two weeks ago?

 

[BlackNDecker]

Wasn't that the NEJM case from two weeks ago?

I failed to renew my subscription 🙁

What did it say?

 

[remedios]

I failed to renew my subscription 🙁

What did it say?

My mistake, it was Q-fever with epitheloid granulomas. Though brucellosis can also cause hepatic granulomas. However, it is unclear from the NEJM article on brucellosis and from emedicine whether these are caseating, non-caseating, or both/either.

I wouldn't lose faith in Qbank just for that though. It's a minor point. The bigger point is that a lot of things can cause granulomas.

 

[BlackNDecker]

I wouldn't lose faith in Qbank just for that though. It's a minor point. The bigger point is that a lot of things can cause granulomas.

👍 Thanks for double checking.

This isn't the only reason for my lack of faith...

 

[remedios]

👍 Thanks for double checking.

This isn't the only reason for my lack of faith...

Q bank definitely has its mistake, as does everything else. As a whole though I would still say it's one of the best study tools, good questions and GREAT answer keys.

It is always good though to double check things that doesn't make sense to you, looking things up in journals/internet etc. It's a great skill to have once third years comes around

 

[OSUdoc08]

Goljan says you only find them in Mycobaterial infections and systemic fungal infections...

Qbank says Brucella abortus can cause caseating granulomas 😕

If a question on the step asks about a pt with malaise, chills fatigue, weakness, and ab pain. Biopsy of colon shows caseating granulomas...most likely cause?

If M. bovis and B. abortus are both listed, would you not choose M. bovis? Even if history reveals living on a farm with cows?

Disclaimer: the Qbank question was a gimme, and did NOT include M. bovis.

B. abortus is not common. Thus, it will never be a "most likely cause" unless there are no mycobacterial or system fungal infections listed.

 

[BlackNDecker]

B. abortus is not common. Thus, it will never be a "most likely cause" unless there are no mycobacterial or system fungal infections listed.

👍 Thanks...

Out of curiosity, have you ever heard "you know who" mention that B. abortus (or anything else for that matter) can cause caseating granulomas? He stresses in his Inflammation lectures that ONLY TB and systemic fungal infections cause caseation...

 

[OSUdoc08]

👍 Thanks...

Out of curiosity, have you ever heard "you know who" mention that B. abortus (or anything else for that matter) can cause caseating granulomas? He stresses in his Inflammation lectures that ONLY TB and systemic fungal infections cause caseation...

He has never mentioned B. abortus in class.

 

[Idiopathic]

B. suis is much more likely to mimic TB (and definitely will cause caseation!) than B. abortus. Chronic B. abortus rarely caseates, but those suis bugs often can.

Poppy just ignores the brucelloses, for the most part. I think he pretty much says they are worthless and moves on.

edit: to answer the OP, i would always choose the mycobacterium in a question like this.