What considerations should be included in your differential diagnosis given the provided histologic finding?
The image of a Jones silver stain depicts a small vessel within the center of the image along with a surrounding, somewhat well-formed non-necrotizing granuloma with associated touton giant cell (approximately 4-5 o’clock). The most common consideration to include in your differential for granulomatous tubulointerstitial nephritis is drug/hypersensitivity reaction.
However, other considerations would also include underlying infection (particularly mycobacterial or fungal), autoimmune disease, as well as sarcoidosis (diagnosis of exclusion).
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