In a patient with berylliosis (chronic beryllium disease), non-caseating granulomas form via CD4+ T-cell recognition of beryllium ions presented by HLA-DP molecules. This differs from tuberculosis granulomas in that:

• A Berylliosis is driven by T-cell hypersensitivity to a non-degradable antigen, forming non-caseating granulomas without central necrosis ✓
• B Berylliosis granulomas lack Langhans giant cells unlike TB granulomas
• C Berylliosis granulomas contain caseating necrosis indistinguishable from TB on biopsy
• D Berylliosis granulomas are CD8+ T-cell dependent rather than CD4+ dependent

Explanation

Berylliosis (chronic beryllium disease) is a T-cell-mediated delayed hypersensitivity (Type IV) granulomatous reaction to beryllium, which cannot be degraded by macrophages — the persistent antigen drives chronic granuloma formation. Because beryllium is not an organism causing necrosis, the granulomas are non-caseating (similar to sarcoidosis), distinguishing them histologically from TB. The diagnosis requires beryllium-specific lymphocyte proliferation test (BeLPT) on BAL or blood. HLA-DPB1 Glu69 allele confers genetic susceptibility.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.