Granulomatous Pneumonia Research Articles

Fatal Meningoencephalitis From a Rhizomucor pusillus Infection in a Juvenile Magellanic Penguin (Spheniscus magellanicus).

A 7-month-old, male Magellanic penguin (Spheniscus magellanicus), housed in an outdoor exhibit, developed acute neurologic signs that progressed to death over 2 days. On gross examination, the bird had congested, edematous lungs, and cerebellar hemorrhage. Histologic examination identified granulomatous pneumonia and encephalitis, with thrombosis and eosinophilic, branching fungal hyphae that had invaded the meningeal vessel walls. Polymerase chain reaction identified the fungus in the brain as Rhizomucor pusillus, an uncommon cause of mucormycosis. This organism has previously been reported in respiratory, skeletal, and sino-orbital lesions of avian species. This clinical report describes meningoencephalitis associated with Rhizomucor pusillus in a penguin.

Pulmonary adiaspiromycosis in armadillos killed by motor vehicle collisions in Brazil

Knowledge of infectious diseases in wildlife provides important information for preventing potential outbreaks of zoonotic diseases. Adiaspiromycosis is a neglected human disease caused by dimorphic Onygenales fungi. The disease is produced by the inflammatory response against growing adiaspores, leading to granulomatous pneumonia. In humans, adiaspiromycosis is relevant in immunosuppressed patients. In animals, it is associated with pneumonia in fossorial species. Given the potential role of armadillos in the epidemiology of adiaspiromycosis, in this study, we sought to investigate the occurrence and pathological features of adiaspiromycosis in roadkilled armadillos. In total, 54 armadillo carcasses were suitable for postmortem pathologic examinations between February 2017 and 2020. Adiaspores, associated with granulomatous lesions, were observed in ten six-banded (Euphractus sexcinctus) and two southern naked-tailed armadillos (Cabassous unicinctus). A previously uncharacterized Onygenales species was molecularly identified in two E. sexcinctus. In summary, herein we report 12 cases of pulmonary adiaspiromycosis (PA) in two species of free-living armadillos in Brazil. Both, the morphology of the fungus, as well as the histopathological findings (granulomatous inflammatory response to adiaspores) are consistent with PA; however, as the molecular identification differs from the reported species, the potential impact of this fungus for human PA is unknown, and we cannot rule out its impact on public health.

Polycystic Kidney Disease in Rough Toothed Dolphins (Steno bredanensis) founded in the Paraná coast, Southern Brazil

Background: Renal cystic diseases (RCD) are characterized by cystic structures on renal parenchyma associated with obstructive lesions, membranous disruptions, and/or growth disturbances. The polycystic kidney disease (PKD) shows specific pathological characteristics, related to mutations on PKD1 and/or PKD2 chromosome locus on humans. In Persian cats and bull terriers the condition is like the human “adult-onset” PKD, while in Perendale sheep the “childhood”-like is described. In cetaceans, RCD are reported, however the characterization of PKD is scarcely described. This report aims to describe two cases of PKD and one of RCD in stranded Steno bredanensis, and to discuss the disease associated factors.Cases: Four rough-toothed-dolphins were found stranded in the Paraná coast, southern Brazil between 2016 to 2018, through the Santos Basin Beach Monitoring Project (PMP-BS), one of the systematic monitoring programs required by Brazilian Institute of Environment and Renewable Natural Resources (IBAMA) for the environmental licensing process of oil production and transport by Petrobras in the presalt province. In three animals histological sampling was performed. One of them (animal 3) was founded alive, presenting altered buoyancy with lateralization to the right and signs of pneumonia. The blood analysis showed anemia and leukocytosis. The animal showed poor clinical prognosis, and even with supportive treatment, come to death four days after the rescue. Routine autopsies were performed on all animals. Animals 1 and 2 presented macroscopically enlarged kidneys containing disseminated cystic structures in the parenchyma. On microscopic examination, the cortical region showed diffuse cystic structures delimited by variable thickness of fibrous tissue, usually compressing adjacent glomeruli, without concomitant inflammatory process. In these cases, the death was associated with the end stage renal disease. Animal 3 showed grossly few cystic structures, well delimited and replacing some reniculi. Tracheitis, granulomatous pneumonia, esophagitis, gastritis, enteritis and papilloma on penis and palate were observed. Microscopically, the cysts were lined by a single layer of columnar to cuboidal epithelial cells surrounded by extensive fibrotic tissue. Multifocal tubular necrosis was also noticed. Multifocal moderate nonsuppurative encephalitis with parasitic eggs and bacterial granulomatous hemorrhagic pneumonia were observed. In this case, the death was associated with the lesions in the nervous system. Discussion: Data concerning polycystic kidney disease on cetaceans and wild animals is limited, and no primary genetic pathway was associated. In the present study, the gross and histological aspects observed on two animals (1 and 2) are similar to the characteristics found in the human adult form of PKD, while the characteristics observed on animal 3 are consistent with usual cystic disease. In addition, the animals are aged like humans where the end stage renal disease occurs in patients around 70 years old. The kidney histological aspects observed in all animals are similar, however, animal 3 showed no renomegaly, a characteristic of PKD. Considering the genetic pathway involved in humans and some animal’s breeds, investigation on gene mutations in S. bredanensis could help to define if this is also a genetic disorder and increase the knowledge about PKD. Keywords: kidney, delphinidae, PKD, diagnostic pathology, cystic disease, rough toothed dolphin.

Severe pneumonia in a street rat (Rattus norvegicus) caused by Rodentibacter rarus strain RMC2

Background Rodents are one of the most dangerous reservoirs and carriers of infectious diseases. Gradually, rats have become predominant in cities, sometimes staying in close vicinity to humans, pets, and other animals. Consequently, they tend to increase the transmission risk of pathogens. Case description Here, we report an original case of bacterial pneumonia in a street rat (Rattus norvegicus). The rat was found dead on a street in the chief town of Marseille (France) after being run over by a car. The necropsy of the corpse revealed generalized granulomatous pneumonia in almost all the pulmonary lobes. Lung lesions and predominantly multiple fibro-inflammatory areas are presumably the witness of an infectious etiology. Bacterial isolation was carried out from lung tissues. Colonies were identified by MALDI-TOF MS and confirmed by 16S rRNA sequencing. The following bacteria were identified: Staphylococcus cohnii, Bordetella bronchiseptica, Bordetella parapertussi, Corynebacterium glucuronolyticum, Pelistega suis and Rodentibacter rarus. Based on the histopathological diagnosis and the avoidance approach, the most likely etiological agent of pneumonia is therefore R. rarus, a little-known Pasteurellales bacterium that is closely related to Rodentibacter pneumotropicus. Conclusion These data emphasize the severity of R. rarus infection in rodents. Thus, pointing out a potential risk for other animals (dogs, cats, and birds), as well as humans. The health monitoring program for rodents and rabbits pasteurellosis should now include R. rarus. Therefore, the pathological effect of the Rodentibacterspecies and/or strains needs to be better explored.

HISTOPLASMOSIS IN NONDOMESTIC FELIDS: A REVIEW OF SIX CASES

One adult leopard (Panthera pardus) and five adult tigers (Panthera tigris) presented with a range of nonspecific clinical signs, including lethargy (6/6), mobility deficits (4/6), and hyporexia (3/6). Hematology and biochemistry revealed a hyperproteinemia characterized by hyperglobulinemia (4/6), hepatocellular enzyme activity increases (3/6), azotemia (3/6), leukocytosis (2/6), hyperbilirubinemia (2/6), or a combination of conditions. Further diagnostics and management varied with the presenting signs and clinicopathological findings, including supportive care, diagnostic imaging, and blastomyces urine antigen analyses. Two animals died, and four were euthanatized. Postmortem findings included granulomatous pneumonia (6/6), fibrinous pleural effusion (3/ 6), pericardial effusion (2/6), and diffuse icterus (1/6). Histopathology revealed round to oval structures with a thin clear wall and purple inclusions within cells of the mononuclear phagocyte system, consistent with Histoplasma capsulatum, in each animal. Disseminated histoplasmosis was found in five cases, with organisms present in the lung (5/5), liver (3/5), lymph nodes (3/5), spleen (2/5), bone marrow (2/5), thyroid (1/5), tongue (1/ 5), kidney (1/5), or a combination of organs. One tiger was found to have pulmonary histoplasmosis without evidence of disseminated infection. On the basis of clinical and pathological findings, histoplasmosis was diagnosed. This case series illustrates the difficulties in antemortem diagnosis of histoplasmosis on the basis of complete blood count, serum biochemistry profile, and antigen testing and underscores that histoplasmosis should be considered a differential diagnosis in any felid presenting with nonspecific clinical signs in endemic areas.

GRANULOMATOUS LUNG DISEASE: A DIAGNOSTIC DILEMMA

SESSION TITLE: Fellows Diffuse Lung Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Granulomatous lung disease (GLD) refers to a large group of infectious and noninfectious diseases. Granulomas are collections of macrophages with giant cells. GLD are diagnostically challenging and require thorough investigation from clinical context and family history to radiographs and biopsy. Often, a diagnosis may still elude the investigator. CASE PRESENTATION: A 53-year-old Italian female presented with intermittent low-grade fevers, nonproductive cough and pleuritic chest pain for several months and was found to be hypoxemic with exertion. She was a non-smoker and a runner who travelled internationally for work conferences and owned cats. Initial evaluation revealed hypoxemia with exertion, peripheral eosinophilia and an elevated C-reactive protein (CRP). Chest x-ray (CXR) was unremarkable but computed tomography (CT) showed bibasilar, centrilobular tree-in-bud nodularity without lymphadenopathy [Figure 1-2]. Bronchoscopy revealed a sterile lymphocytosis. A video-assisted thoracoscopic surgery (VATS) biopsy was done which showed peribronchovascular and subpleural non-caseating granulomas with giant cells and plugs of organizing pneumonia. These findings were suggestive of sarcoidosis with atypical radiologic features; however, external review by a separate pathologist suggested hot tub lung syndrome as a possibility. DISCUSSION: This case posed several radiologic and pathologic challenges. Centrilobular nodules are seen in hypersensitivity pneumonitis (HP), asbestosis, Langerhans cell histiocytosis (LCH) and bronchiolitis, the latter of which can be seen as tree-in-bud along with aspiration. The differential for GLD is broad and includes infection (tuberculosis, non-tuberculous mycobacterium (NTM), endemic fungi) and noninfectious etiologies (lymphoma, ANCA-associated vasculitides, LCH, inflammatory bowel disease, drug-induced, sarcoidosis and exposure related diseases such as HP, hot tub lung syndrome and pneumoconiosis). Peribronchovascular granulomas suggested sarcoidosis, but other classic radiologic features of sarcoidosis were absent. ACE and calcium levels were normal and there was no other obvious organ involvement. The imaging did fit with hot tub lung syndrome and she had granulomas in the airways as well as hot tub exposure but cultures were negative for NTM. After extensive infectious and rheumatologic workup was negative, she was trialed on empiric steroids and had symptomatic resolution. CONCLUSIONS: It is important to understand the etiology of infectious and noninfectious GLDs as treatments vary depending on the cause. In our case, we were unable to identify the single, unifying diagnosis despite thorough investigation. A noninfectious etiology was presumed and steroids ultimately proved to be successful. Reference #1: Cheung OY, et al. Surgical Pathology of Granulomatous Interstitial Pneumonia. Ann Diagn Pathol. 2003; 7(2):127-38. doi: 10.1053/adpa.2003.50018. Reference #2: Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and Detection of Sarcoidosis. Am J Respir Crit Care Med. 2020; 201(8):e26-e51. doi: 10.1164/rccm.202002-0251ST. Reference #3: Swensen SJ, et al. Lung Nodule Enhancement at CT: A Multicenter Study. Radiology. 2000; 214(1):73-80. doi: 10.1148/radiology.214.1.r00ja1473. DISCLOSURES: No relevant relationships by Cristina Reichner, source=Web Response No relevant relationships by Jigna Solanki, source=Web Response

Unusual severe fungal pneumonia in Vietnamese potbelly pigs: two cases

Two 18-month-old, castrated male Vientamese potbelly pigs presented for diagnosis and treatment of respiratory disease of two to three weeks duration which had been non-responsive to antibiotic therapy. The pigs...

Granulomatous Inflammation of the Muzzle in White-Tailed Deer (Odocoileus virginianus) and Mule Deer (Odocoileus hemionus) Associated With Mannheimia granulomatis.

Since 2002, reports of deer with swollen muzzles from throughout the United States have resulted in significant interest by wildlife biologists and wildlife enthusiasts. The condition was identified in 25 white-tailed deer (Odocoileus virginianus) and 2 mule deer (O. hemionus). Microscopic lesions consisted of severe, granulomatous or pyogranulomatous inflammation of the muzzle, nasal planum, and upper lip, as well as similar but less severe inflammation of the hard palate. Lymphadenitis of regional lymph nodes was common and granulomatous pneumonia was present in one individual. Splendore-Hoeppli material was typical in the center of inflammatory foci. Other than the single instance of pneumonia, systemic disease was not evident. Various bacterial species were isolated in culture, most of which were not morphologically consistent with the colonies of small, gram-negative bacteria observed in the center of the granulomas. Amplification and sequencing of the bacterial 16S rRNA gene from tissues of affected deer resulted in the identification of Mannheimia granulomatis. Laser capture microdissection was used to confirm that the colonies in the inflammatory foci were M. granulomatis. The cases described here are reminiscent of a bovine disease in Brazil and Argentina, locally called lechiguana. Although the inflammation of lechiguana is mostly truncal, the microscopic lesions are very similar and are also attributed to M. granulomatis. It is unclear if this is an emerging infectious disease of deer, or if it is a sporadic, uncommon condition that has only recently been recognized.

Granulomatous pneumonia due to pythiosis in captive South American coatis (Nasua nasua)

ABSTRACT: Pythiosis is an emerging infectious disease affecting captive and free-ranging wild animals. We report granulomatous pneumonia due to Pythium insidiosum in two South American coatis (Nasua nasua), who were found dead without any clinical records. Severe granulomatous pneumonia associated with pleural effusion was revealed in the necropsy. Microscopically, variably sized granulomas and pyogranulomas presented negative hyphae profiles at the periphery of their necrotic cores. Grocott methenamine silver stain highlighted these structures, and immunostain (anti- P. insidiosum) was strongly positive. Molecular analysis by polymerase chain reaction amplified P. insidiosum specific DNA. These findings characterized P. insidiosum as a cause of granulomatous pneumonia in coatis and proved that pythiosis needs to be considered in the differential diagnosis of respiratory diseases affecting this species in endemic areas.

Causes and Pathology of Equine Pneumonia and Pleuritis in Southern Brazil

We document the causes and pathological findings in 50 cases of equine pneumonia and pleuritis in Southern Brazil. Suppurative (17/50), pyogranulomatous (14/50), aspiration (5/50), mycotic (4/50), bronchointerstitial (3/50), embolic (3/50) and eosinophilic granulomatous pneumonia (1/50) and pleuritis (3/50) were the main conditions identified. Streptococcus spp. were identified in 11 cases of suppurative pneumonia. Suppurative pneumonia was further divided into acute (8/17), subacute (6/17) and chronic (3/17) based on the morphological pattern of lesions. Rhodococcus equi was identified in all cases of pyogranulomatous pneumonia and exclusively affected young foals.

8. The Role of Bovine Viral Diarrhea Virus In Bovine Respiratory Disease Complex In Cattle Import Livestock At 2019 Periode

Bovine viral diarrhea virus (BVDV) is one of the most important infectious diseases in cattle breeding. Bovine respiratory disease complex (BRDC) is a respiratory disease in mature and calf cattle which is a viral and bacterial superinfection including BVDV. The purpose of reseach is to study the role of BVDV in cases of Bovine respiratory disease complex (BRDC), especially with the characteristic of lesions were granulomatous pneumonia. The material in this study was lung tissue that was fixed with 10% formaldehyde buffer of calf sampel collected in October and November 2019. The sample is processed in a pathology laboratory for hematoxyline eosin (HE) staining and followed by immunohistochemical staining (IHC). A total of 11 lung samples sent from imported beef cattle and dairy cattle with a diagnosis of pneumonia complex morphology continued with CPI testing with monoclonal antibodies against bovine viral diarrhea virus. Nine samples showed positive CPI results against BVDV and two other samples were negative. Bovine viral diarrhea virus is detected in all granulomatous pneumonia, so it has an important role in BRDC. Early detection, treatment and prevention of BRDC affected or followed by BVDV must be carried out programmatically.

75 Rhinocladiella-Associated Granulomatous Pneumonia Causing Hypercalcemia and Acute Kidney Injury in Renal Transplant Recipient

75 Rhinocladiella-Associated Granulomatous Pneumonia Causing Hypercalcemia and Acute Kidney Injury in Renal Transplant Recipient

Pathological Studies on lung affections in sheep and goat at Kalubia Governorate

The gross and histopathological changes in the lungs of small ruminants at Kalubia Governorate were investigated. A total of 159 lung samples (134 sheep and 25 goats) showed gross lesions were collected from February 2018 till November 2019. Bacterial strains were isolated from 26 cases out of 159 (16.35%) including various types where Staphylococcus aureus was the most predominant isolated strain from the lungs. Based on histopathological examination, different types of pneumonia (28.9%) including; suppurative pneumonia (10.69%), fibrinous pneumonia (7.54%), interstitial pneumonia (6.28%), granulomatous pneumonia (1.26%) and verminous pneumonia (3.14%) were detected. Bronchitis and bronchiolitis (21.38%); pleural fibrosis (4.4%) were recorded. Pulmonary adenomatosis and fibrosarcoma were detected in lungs of sheep with an incidence of 2.52% and 1.26% respectively. The study concluded that pneumonia is an important lesion in the lungs of small ruminant, and suppurative Pneumonia was the most predominant type. Verminous Pneumonia was detected only in goats and not detected in sheep. Pulmonary adenomatosis were recorded in lungs of sheep but not observed in goat.

Immune reconstitution inflammatory syndrome associated with granulomatous Pneumocystis pneumonia co-infected with Mycobacterium avium in an HIV-infected patient

Immune reconstitution inflammatory syndrome associated with granulomatous Pneumocystis pneumonia co-infected with Mycobacterium avium in an HIV-infected patient

37. Risk Factors for Granulomatous Pneumonia Incidence in Lampung Breeding Farm

Complex respiratory disease in the calf (enzootic calves pneumonia) is a complex respiratory disease (bovine respiratory disease complex/BRDC) caused by co-infection with viral, bacterial or fungal pathogens. Granulomatous pneumonia is one of the dominant lesions in BRDC that characterizes the infection of Mycoplasma bovis, a bacterium that is very strong against phagocytosis of immun cells. This study aims to determine the presence of risk factors associated with the incidence of granulomatous pneumonia. This study used secondary data from Laboratory of Pathology in Balai Veteriner Lampung, Sample collection in 2015-2017 period from one of the breeding farm in Lampung. Data is processed by calculating frequency, tables and logistic regression in Epi-info tools. The frequency of granulomatous pneumonia at the age of pre weaning and weaning was 63.06% and 36.94%, breed Wagyu and Brahman cross (76.12% and 23.88%), as well as males and females (61.01% and 38.99%). The results of measurements with Epi-info show that the age factor (Odds ratio = 2.16, 95% CI = 1.51-3.09) and breeds (Odds ratio = 1.52, 95% CI = 1.003-2.31) were associated with the incidence of granulomatous pneumonia. Based on the results of research that Wagyu calf and weaning age are more at risk of granulomatous pneumonia.

Severe hypercalcemia preceding a diagnosis of Pneumocystis jirovecii pneumonia in a liver transplant recipient

BackgroundIncidence of the opportunistic infection Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant patients ranges from 5 to 15% with a mortality of up to 38%.Case presentationWe present a liver transplant recipient who developed hypoxemic respiratory failure related to PJP soon after treatment for allograft rejection. His presentation was preceded by severe hypercalcemia of 14.6 mg/dL and an ionized calcium of 1.7 mmol/L which remained elevated despite usual medical management and eventually required renal replacement therapy. As approximately 5% of PJP cases have granulomas, here we review the role of pulmonary macrophages and inflammatory cytokines in the pathophysiology of granuloma-mediated hypercalcemia. We also discuss the interpretation of our patient’s laboratory studies, response to medical therapy, and clinical risk factors which predisposed him to PJP.ConclusionsIt is important for clinicians to consider PJP as an etiology of granulomatous pneumonia and non-parathyroid hormone mediated hypercalcemia in chronically immunosuppressed organ transplant recipients for timely diagnosis and management.

Comparative detection of bovine herpesvirus-1 using antigen ELISA, immunohistochemistry and immunofluorescence methods in cattle with pneumonia

This study was conducted to detect the prevalence and presence of bovine herpesvirus-1 (BoHV-1) using immunohistochemistry (IHC), immunofluorescence (IF) and antigen enzyme-linked immunosorbent assay (ELISA) in the lung samples of cattle (n = 1023). In addition, three methods were compared using receiver operating characteristic (ROC) and chi-square test ($χ^{2}$ test), and their usability were evaluated in laboratory conditions. Macroscopically, pneumonia was seen in 120 of the lung tissue samples (11.73%). Based on the microscopic examinations, the pneumonia types were classified as catarrhal-suppurative bronchopneumonia (6.7%), fibrinous bronchopneumonia (5%), interstitial pneumonia (84.1%), and granulomatous pneumonia (4.2%). The IHC, IF and antigen ELISA positivity were 48.33%, 50.83%, and 29.9%, respectively. Considering IF as a gold standard, IHC had more acceptable sensitivity and specificity than antigen ELISA. In conclusion, it has been observed that when IF method is not available, IHC is more reliable than antigen ELISA in the diagnosis of BoHV-1.

Parasites of Boa constrictor (Squamata: Boidae) captive in Colima, Mexico and their pathological effects

The main objectives of this study were to report the parasites found in 16 Boa constrictor Linnaeus, 1758 captive in the Environmental Management Unit “El Palapo” Colima, Mexico, from 2013 to 2015, as well as to describe their pathological effects. All snakes had at least a parasite infection or a metabolic alteration. The parasites recorded include 1 Ascomycota ( Aspergillus sp.); 1 Actinobacteria ( Mycobacterium sp.); 2 Apicomplexa ( Hepatozoon sp. and Cryptosporidium sp.); 1 cestode ( Crepidobothrium sp.); 1 nematode ( Macdonaldius oschei Chabaud et Frank, 1961); and 3 Arthropoda [ Ophionyssus natricis (Gervais, 1844), Amblyomma dissimile Koch, 1844 (Acari) and Porocephalus sp. (Maxillopoda)]. The pathological effects recorded consisted of: visceral gout (in 31.2% of the snakes); granulomatous pneumonia (12.5%); erythrocytic hypertrophy (25%); heterophilic gastritis (18.7%) and enteritis (25%); heterophilic thrombosis and vasculitis (6.25%); heterophilic dermatitis (25%), and finally, focal pneumonitis (6.25%). The captivity of these snakes, without the support of preventive medicine, should be considered as a risk factor for the manifestation or exacerbation of metabolic and infectious pathologies.

Fatal Tuberculosis in a Free-Ranging African Elephant and One Health Implications of Human Pathogens in Wildlife.

Tuberculosis (TB) in humans is a global public health concern and the discovery of animal cases of Mycobacterium tuberculosis (Mtb) infection and disease, especially in multi-host settings, also has significant implications for public health, veterinary disease control, and conservation endeavors. This paper describes a fatal case of Mtb disease in a free-ranging African elephant (Loxodonta africana) in a high human TB burden region. Necropsy revealed extensive granulomatous pneumonia, from which Mtb was isolated and identified as a member of LAM3/F11 lineage; a common lineage found in humans in South Africa. These findings are contextualized within a framework of emerging Mtb disease in wildlife globally and highlights the importance of the One Health paradigm in addressing this anthroponotic threat to wildlife and the zoonotic implications.

Pathology and metagenomics based diagnosis of tuberculosis in Bikaneri Camel (Camelus dromedarius)

Three Bikaneri camels with chronic illness and weak body condition were received for post mortem examination in the Department of Veterinary Pathology from Border Security Force, Barmer, Rajasthan, India. Gamma glutamyl transferase (GGT) and Alkaline phosphatase (ALP) in all camels were increased. Gross necropsy findings were diffuse hemorrhagic tracheitis, mild to moderate pleuritis, granulomatous pneumonia and granulomatous lymphadenitis in mediastinal lymph nodes. White to gray, firm, multilobulated, multifocally mineralized, granulomatous mass were found on right and left lobes of lung parenchyma. Mediastinal lymph nodes revealed mild to severe enlargement with multifocal mineralization and fi rm granulomatous mass. Histopathologically, infiltration of mononuclear inflammatory cells and RBCs were found in trachea and larynx. Lungs and mediastinal lymph nodes showed typical granulomatous inflammation. Pink coloured acid-fast bacilli arranged in clumps/bunch were found in lung tissue section stained by Ziehl-Neelsen staining. Further, 16S rRNA amplicons sequencing was used for molecular characterization of different Mycobacterium spp.