Caseous Necrosis

Caseous necrosis is a pattern of cellular death that causes a crumbly, white appearance of the tissue under a microscope. Caseous (pronounced KAY-see-us) means “cheese-like.” Necrosis is the medical term for tissue death.

Unlike other forms of necrosis (such as gangrene), you typically can’t see caseous necrosis. It forms in granulomas (clusters of immune cells) — often in organs like your lungs. Your healthcare provider may call it a caseating granuloma. Caseous necrosis itself isn’t harmful to your health. But conditions that cause it can be.

Symptoms of caseous necrosis

Caseous necrosis itself typically doesn’t lead to symptoms. But you may have symptoms of the underlying infection that causes it. For example, active tuberculosis in your lungs can give you chest pain and chronic coughing.

Caseous necrosis causes

Certain bacterial and fungal infections can cause caseous necrosis.

The bacteria behind tuberculosis (TB) is the most common cause. TB often affects your lungs. But it can spread to other organs and body systems. With TB, necrosis can happen in granulomas if your body can’t control the infection. Caseous necrosis in TB is linked to complications and the spread of the bacteria to other people.

Other infections that can cause caseous necrosis include:

• Cryptococcosis: A fungal infection that can affect your brain, lungs or other parts of your body
• Histoplasmosis: A fungal infection that often affects your lungs but can spread to other parts of your body
• Syphilis: A bacterial sexually transmitted infection (STI)
• Valley fever: A fungal infection in your lungs

How doctors diagnose it

It’s not always necessary to diagnose caseous necrosis. This is because the underlying cause of it needs diagnosis and treatment, not the necrosis itself. Specialists who diagnose diseases (pathologists) can confirm caseous necrosis. They look at a sample of tissue under a microscope. The tissue sample comes from a biopsy.

Biopsies are an invasive procedure and may have risks. So, your healthcare provider may use other tests to diagnose the underlying condition. For example, they may do chest X-rays or take a sputum (spit) sample.

How is it treated?

Treatment for caseous necrosis involves treating the underlying infection. Your healthcare provider may prescribe antibiotics or antifungal medications.