Bone Marrow Granuloma in Typhoid Fever: A Morphological Approach and Literature Review

Figure 2

Schematic line representation of various morphological patterns of bone marrow granulomas associated with different etiologies. (a) Lipid granuloma commonly described in the earlier literature, (b) tubercular caseating epithelioid granuloma with Langhans giant cell, (c) fibrin ring/“doughnut” granuloma seen in Q-fever, brucellosis, and sometimes in viral infections, (d) histiocytic/epithelioid granuloma with erythrophagocytosis in typhoid fever, (e) epithelioid granuloma seen in Hodgkin lymphoma and surrounding atypical mononuclear cells and polymorphous inflammatory infiltrate, and (f) naked, noncaseating (sarcoidal type) epithelioid granuloma seen in sarcoidosis. Ab: asteroid body, Cn: caseous necrosis with eosinophilic, granular appearance; Eo: eosinophils; Ep: epithelioid histiocytes with characteristic elongated, slipper shaped nuclei; Eph: erythrophagocytosis; Fn: fibrinoid necrosis/material; G: multinucleated giant cell; H: foamy histiocytes with or without engulfed debris; Hg: mononuclear Hodgkin cell with eosinophilic macro nucleoli; L: lymphocytes; Lv: lipid vacuole; Lg: Langhans giant cell; Pl: plasma cells; RSG: Reed-Sternberg giant cell characterized by mirror image nuclei with eosinophilic macro nucleoli.

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