# Necrotizing granuloma **URL:** \ **Category:** Factual Questions\ **Created:** [May 29, 2006, 4:43am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594 "2006-05-29T04:43:39Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [May 29, 2006, 4:43am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/1 "2006-05-29T04:43:39Z")
This is a fairly obscure question and, without meaning to underestimate the collective wisdom of my fellow dopers, I’m really hoping that **gabriela** , in particular, might be able to answer (Of course, if you do know the answer, please, please, don’t be shy). I have a patient with longstanding but gradually worsening necrotizing granulomata in his abdominal and retroperitoneal lymph nodes (biopsy confirmed - with AFB and all other special stains negative). The largest node now measures 4 cm in max length. His primary complaint is severe abdominal pain, and he is also having fevers but no other constitutional symptoms. The most interesting and confusing thing about this is that he has had Crohn’s disease for a number of years, albeit completely clinically inactive at this time. Even more intriguing IMO is that his abdominal symptoms first began, and radiographic evidence of the adenopathy was first detected, shortly after taking a course of high dose prednisone for a Crohn’s flair about four years ago. He’s born in Canada, never had TB or TB exposure. CXR normal. Besides hoping to get any additions to my list of differentials for necrotizing granulomata (fungal infections, cat scratch, LGV, TB, actinomycosis, Wegener’s, lymphoma, and rarely sarcoid), my question, and my purpose in posting this, **gabriela** , is to ask whether Crohn’s itself can lead to necrotizing granulomata in abdominal nodes? Any idea? Thanks! ---
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [May 29, 2006, 5:08am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/2 "2006-05-29T05:08:43Z")
I got nothin - But here are some links that may be of interest [Gastrointestinal Involvement in Chronic Granulomatous Disease](http://pediatrics.aappublications.org/cgi/content/full/114/2/462)? [Necrotizing Granulomata in the Lung Preceding Colonic Involvement in 2 Patients with Crohn’s Disease](http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=224278&Ausgabe=0&ArtikelNr=92854) [Wegener’s Granulomatosis in a Patient with Crohn’s Disease\*](http://medic.bgu.ac.il/homes/shlomi/articles/wegener_IMAJ.pdf) ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [May 29, 2006, 5:16am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/3 "2006-05-29T05:16:12Z")
> [@astro](#): > > I got nothin - But here are some links that may be of interest > [Gastrointestinal Involvement in Chronic Granulomatous Disease](http://pediatrics.aappublications.org/cgi/content/full/114/2/462)? > > [Necrotizing Granulomata in the Lung Preceding Colonic Involvement in 2 Patients with Crohn’s Disease](http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=224278&Ausgabe=0&ArtikelNr=92854) > > [Wegener’s Granulomatosis in a Patient with Crohn’s Disease\*](http://medic.bgu.ac.il/homes/shlomi/articles/wegener_IMAJ.pdf) Thanks. I was aware of the 2nd article, in particular, and wondered whether similar cases existed where the abdominal nodes were involved (and not the lung). Appreciate your efforts! ---
**Author:** ![gabriela](https://avatars.discourse-cdn.com/v4/letter/g/db5fbb/32.png) [@gabriela](https://boards.straightdope.com/u/gabriela)\ **Post date:** [May 29, 2006, 11:12am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/4 "2006-05-29T11:12:17Z")
I’m truly sorry, **KarlGauss** , but I have no expertise to add to this. My chief area of expertise is in fatal disease, and necrotizing granulomata are rarely fatal. I have run across them as incidental and interesting findings, but that means my knowledge is completely anecdotal. However, I am sure the Crohn disease cannot be irrelevant, since it is a disorder likely related to the imbalance between Th1 and Th2 responses, with Th1 aggressively elevated in Crohn, and Th2 in responses to helminthic infection, leading to my current favorite of all therapies, TSO (trichuris suis ova for Crohn disease, or drink a glass of pig whipworm eggs and feel better!). [Pig whipworm egg therapy for Crohn disease](http://gut.bmjjournals.com/cgi/content/full/54/1/6) Necrotizing granulomata have been related to Th1 increases before now, outside the setting of Crohn’s (Gross WL, Trabandt A, Csernok E. Pathogenesis of Wegener’s granulomatosis. Ann Med Interne 1998; 149: 280; quoted in [this article](http://64.233.161.104/search?q=cache:OMDGB8w8wPoJ:www.imbiomed.com/Innsz/Nnv53n1/Nn011-08z.pdf+Th1+inflammatory+necrotizing+granulomata&hl=en&gl=us&ct=clnk&cd=3&client=safari) . Best I can do. My regrets. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [May 29, 2006, 4:14pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/5 "2006-05-29T16:14:44Z")
> [@gabriela](#): > > I’m truly sorry, **KarlGauss** , \. No problemo. Thanks! ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [May 29, 2006, 4:16pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/6 "2006-05-29T16:16:39Z")
Neat article, btw. Thx. ---
**Author:** ![Beware\_of\_Doug](https://avatars.discourse-cdn.com/v4/letter/b/278dde/32.png) [@Beware\_of\_Doug](https://boards.straightdope.com/u/Beware_of_Doug)\ **Post date:** [May 29, 2006, 4:33pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/7 "2006-05-29T16:33:16Z")
MIsread as: **Necrotizing grandma** :eek: ---
**Author:** ![Sunspace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sunspace/32/1250_2.png) [@Sunspace](https://boards.straightdope.com/u/Sunspace)\ **Post date:** [May 29, 2006, 5:03pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/8 "2006-05-29T17:03:43Z")
Word rated most likely _not_ to be part of one of **Sunspace** ’s image searches: “Necrotizing”. :: shudder :: Seriously, I don’t know how you medical people can do your jobs. Hats off to you. ---
**Author:** ![Beware\_of\_Doug](https://avatars.discourse-cdn.com/v4/letter/b/278dde/32.png) [@Beware\_of\_Doug](https://boards.straightdope.com/u/Beware_of_Doug)\ **Post date:** [May 29, 2006, 5:37pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/9 "2006-05-29T17:37:49Z")
> [@gabriela](#): > > my current favorite of all therapies, TSO (trichuris suis ova for Crohn disease, or drink a glass of pig whipworm eggs and feel better!). [Pig whipworm egg therapy for Crohn disease](http://gut.bmjjournals.com/cgi/content/full/54/1/6) Crohn’s is particularly common among people of Jewish origin. Now comes a therapy many of them are religiously obligated _not_ to take. Og _does_ have a sense of humor, and it is a sadistic one. :dubious: ---
**Author:** ![Long\_Time\_First\_Time](https://avatars.discourse-cdn.com/v4/letter/l/ad7895/32.png) [@Long\_Time\_First\_Time](https://boards.straightdope.com/u/Long_Time_First_Time)\ **Post date:** [May 29, 2006, 6:45pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/10 "2006-05-29T18:45:52Z")
> [@Beware of Doug](#): > > Crohn’s is particularly common among people of Jewish origin. > Now comes a therapy many of them are religiously obligated _not_ to take. > > Og _does_ have a sense of humor, and it is a sadistic one. :dubious: The whipworm’s natural host is the pig, but they are worms, not pigs themselves . Unless you’re getting at the fact they don’t have cloven hooves… ---
**Author:** ![jjimm](https://avatars.discourse-cdn.com/v4/letter/j/ba8739/32.png) [@jjimm](https://boards.straightdope.com/u/jjimm)\ **Post date:** [May 29, 2006, 6:55pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/11 "2006-05-29T18:55:16Z")
> [@Beware of Doug](#): > > MIsread as: **Necrotizing grandma** :eek: Misread as: **Necrotizing granola** :eek: ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [May 29, 2006, 6:56pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/12 "2006-05-29T18:56:13Z")
> [@Sunspace](#): > > Word rated most likely _not_ to be part of one of **Sunspace** ’s image searches: “Necrotizing”. > > :: shudder :: > > Seriously, I don’t know how you medical people can do your jobs. Hats off to you. Are you kidding? Being able to toss the word necrotizing around a conversation is it’s own reward. ---
**Author:** ![Beware\_of\_Doug](https://avatars.discourse-cdn.com/v4/letter/b/278dde/32.png) [@Beware\_of\_Doug](https://boards.straightdope.com/u/Beware_of_Doug)\ **Post date:** [May 29, 2006, 6:59pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/13 "2006-05-29T18:59:36Z")
> [@Long Time First Time](#): > > The whipworm’s natural host is the pig, but they are worms, not pigs themselves . > > Unless you’re getting at the fact they don’t have cloven hooves… Yeahyeahrightright. I know too that observant Jews can suspend their dietary laws when obeying them would injure their health. So maybe I should have said Og has a sense of irony, and leave it at that… ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 29, 2006, 11:24pm UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/14 "2006-05-29T23:24:38Z")
> [@Beware of Doug](#): > > Crohn’s is particularly common among people of Jewish origin. > Now comes a therapy many of them are religiously obligated _not_ to take. > > Og _does_ have a sense of humor, and it is a sadistic one. :dubious: If consumption of something non-kosher is required to preserve life and health it IS permitted to Jews. Indeed, if the alternative is death such consumption is _required_ as preservation of life takes precedence over just about anything else. Zev Steinhardt has covered that multiple times, as have other Jewish Dopers. ---
**Author:** ![Sunspace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sunspace/32/1250_2.png) [@Sunspace](https://boards.straightdope.com/u/Sunspace)\ **Post date:** [May 30, 2006, 2:27am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/15 "2006-05-30T02:27:22Z")
> [@outlierrn](#): > > Are you kidding? Being able to toss the word necrotizing around a conversation is it’s own reward. But being cursed with a visual imagination and seeing pictures of the condition is not. 😉 ---
**Author:** ![Smeghead](https://avatars.discourse-cdn.com/v4/letter/s/f1d935/32.png) [@Smeghead](https://boards.straightdope.com/u/Smeghead)\ **Post date:** [May 30, 2006, 5:20am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/16 "2006-05-30T05:20:35Z")
Now, now, now, Doc. I hate to be a junior mod here, but surely you of all people understand the rule about asking medical questions on the boards! 😃 ---
**Author:** ![gabriela](https://avatars.discourse-cdn.com/v4/letter/g/db5fbb/32.png) [@gabriela](https://boards.straightdope.com/u/gabriela)\ **Post date:** [May 30, 2006, 9:42am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/17 "2006-05-30T09:42:35Z")
> [@Broomstick](#): > > If consumption of something non-kosher is required to preserve life and health it IS permitted to Jews. Indeed, if the alternative is death such consumption is _required_ as preservation of life takes precedence over just about anything else. Zev Steinhardt has covered that multiple times, as have other Jewish Dopers. I should also say that I have been informed by a conservative rabbi that when the public health and welfare requires an autopsy of a Jewish person, that is one of the rare exceptions permitted by the (Talmud/Torah - don’t know the right word here). Even when the Jewish person is a tragically dead eight year old girl whose father is a doctor who really doesn’t want her autopsied. ---
**Author:** ![cerberus](https://avatars.discourse-cdn.com/v4/letter/c/71e660/32.png) [@cerberus](https://boards.straightdope.com/u/cerberus)\ **Post date:** [May 31, 2006, 1:45am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/18 "2006-05-31T01:45:50Z")
[link on CD and abnormal permiability](http://www.medscape.com/viewarticle/531603) This might be a longshot, but what the Hell. ---
**Author:** ![Guinastasia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/guinastasia/32/5751_2.png) [@Guinastasia](https://boards.straightdope.com/u/Guinastasia)\ **Post date:** [May 31, 2006, 2:12am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/19 "2006-05-31T02:12:16Z")
> [@cerberus](#): > > [link on CD and abnormal permiability](http://www.medscape.com/viewarticle/531603) > > This might be a longshot, but what the Hell. You have to be a member of that site to view the article. ---
**Author:** ![cerberus](https://avatars.discourse-cdn.com/v4/letter/c/71e660/32.png) [@cerberus](https://boards.straightdope.com/u/cerberus)\ **Post date:** [May 31, 2006, 3:08am UTC](https://boards.straightdope.com/t/necrotizing-granuloma/358594/20 "2006-05-31T03:08:25Z")
It’s free to register, and I have to imagine that an MD would likely be a member already…