Caseous Necrosis

What is caseous necrosis?

Caseous necrosis is a type of cellular death that occurs in tissues. Caseous means “cheese-like” and describes the crumbly, white appearance of the tissue after it dies.

How does caseous necrosis develop?

Caseous necrosis is caused by different infections in your body. When this happens, your body’s immune system responds to the infection, sometimes leading to necrosis, including caseous necrosis.

In caseous necrosis, the invaders are usually bacteria or fungi.

What are the other types of necrosis?

Other types of necrosis include:

• Coagulative necrosis: A low blood supply causes cells to die. This can occur anywhere in your body except your brain. When the cells die, their structure remains intact until your body’s defenses clear them away.
• Fat necrosis: When fat cells die, chemical reactions can leave chalky white deposits. This can occur in pancreatitis, when your pancreas releases chemicals that kill fat cells in your abdomen. In breast tissue, fat necrosis can occur after surgery or trauma.
• Fibrinoid necrosis: This type of necrosis occurs in the inner lining of your blood vessels. When these cells become damaged, lesions form, which can cause bruising and internal and external bleeding.
• Liquefactive necrosis: Cells lose their structure and liquefy. In a bacterial infection, this liquefied material is called pus. Liquefactive necrosis is also the main type of necrosis that occurs in your brain and spinal cord.

What causes caseous necrosis?

Tuberculosis (TB) is the most common cause of caseous necrosis. TB is a bacterial disease of the lungs (pulmonary). It can also spread to other organs and systems throughout your body.

TB can be latent or active. In latent TB infection, the bacteria lie dormant in your lungs but don't cause symptoms. In some people, TB will stay dormant for their entire lives. In others, the bacteria become active right away or reactivate after a latent period. Babies, young children and people with weak immune systems are at higher risk of developing active TB.

Other diseases that can cause caseous necrosis include:

• Histoplasmosis: A respiratory illness caused by a fungus in the soil. Like TB, it can spread to other parts of your body.
• Syphilis: A sexually transmitted infection that leads to degeneration of your nervous system.

What are the symptoms of caseous necrosis?

Symptoms are related to the disease or condition that's causing it. For active TB in your lungs, symptoms include:

• Chest pain.
• Cough lasting longer than two weeks.
• Coughing up blood or mucus.
• Fatigue.
• Fever, chills and night sweats.
• Loss of appetite and weight loss.

How is caseous necrosis diagnosed?

Specialists who diagnose diseases (pathologists) verify caseous necrosis by looking at a sample of tissue under a microscope (biopsy). Biopsies can be invasive because they require taking a tissue sample from your body. Healthcare providers typically don’t use them if less invasive techniques are available to diagnose the underlying conditions.

For example, diagnosis of pulmonary TB is based on a chest X-ray and laboratory testing of sputum (mucous from your lungs). New molecular testing technologies that look for DNA in sputum samples are helping providers diagnose TB faster and with greater accuracy.

How is caseous necrosis treated?

Healthcare providers treat the conditions that cause caseous necrosis.

TB treatment is usually several months long and may involve multiple medications. This is because TB can be antibiotic resistant. Your provider will establish a treatment regimen for you and help you manage side effects from the medications.

How can I prevent tuberculosis?

Tuberculosis spreads from person to person through the air. When an infected person breathes or talks, they can transmit TB to others nearby.

TB is more common in countries outside the U.S., including India, China and Indonesia. When traveling, you can prevent exposure by avoiding close contact with people with TB. TB is more common in settings such as clinics, hospitals and homeless shelters.

If you have latent TB infection, talk to your healthcare provider about treatment to prevent active TB.

TB screening is also important if you may have been exposed to TB. Mantoux skin tests can detect TB exposure and latent TB infection. Talk to your provider about whether you should receive this screening test.

What is the prognosis for people with caseous necrosis?

Treatment for TB is usually effective and most people have a good outcome. Without treatment, half of people with TB will die from the disease.

When should I see my healthcare provider?

If you have been exposed to TB, follow-up care with your healthcare provider is critical. A quick skin test can let you know if you have latent TB and whether you need treatment to prevent active disease.

A note from Cleveland Clinic

Conditions that cause caseous necrosis are treatable. Routine visits with your healthcare provider can help you assess your risks for these conditions, detect any problems early and manage your overall health.