Grappling with the granuloma: where is the ACE in the hole?

The finding of granulomas on paediatric tissue biopsy is non-specific, with a wide differential diagnosis that includes chronic infection (eg, tuberculous, atypical Mycobacterium infection, leprosy, Lyme disease, brucellosis, syphilis and histoplasmosis), immunodeficiency (hyper-IgM syndrome, chronic granulomatous disease), connective tissue disease (juvenile chronic arthritis) and miscellaneous conditions such as Blau’s syndrome,...