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    Subjects/Pathology/Granulomatous Inflammation
    Granulomatous Inflammation
    hard
    microscope Pathology

    A 52-year-old male farmer from Punjab with a 3-year history of chronic cough and hemoptysis presents with low-grade fever and weight loss. On examination, he has clubbing of fingers and crackles in the upper lobes bilaterally. Sputum smear microscopy is negative for acid-fast bacilli on three occasions. High-resolution CT chest shows cavitary lesions in the upper lobes with surrounding consolidation. Transbronchial biopsy shows caseating granulomas with central necrosis. Culture on Löwenstein–Jensen medium grows slow-growing, buff-colored colonies after 6 weeks. What is the most likely diagnosis?

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