Wegener's Granulomatosis (Granulomatosis with Polyangiitis): This is a form of vasculitis that affects small- and medium-size vessels and is characterized by the presence of necrotizing granulomas, particularly in the respiratory tract. It often presents with a combination of respiratory and renal symptoms.

Tuberculosis: While not always necrotizing, granulomas in tuberculosis can exhibit necrosis, especially in the lungs. The presence of caseating granulomas is a hallmark of this infection.
Sarcoidosis: Although typically non-necrotizing, sarcoidosis can rarely present with necrotizing granulomas. It is a systemic disease characterized by the formation of non-caseating granulomas in various organs, most commonly the lungs and lymph nodes.
Infectious Diseases (e.g., Histoplasmosis, Coccidioidomycosis): Certain fungal infections can cause necrotizing granulomas, especially in immunocompromised individuals. These infections are often endemic to specific geographic regions.

Lymphoma: Certain types of lymphoma, such as Hodgkin lymphoma, can present with granulomatous inflammation, including necrotizing granulomas. Missing this diagnosis could lead to delayed treatment of a potentially curable cancer.
Invasive Fungal Infections: In immunocompromised patients, invasive fungal infections (e.g., Aspergillosis) can cause necrotizing granulomas and have a high mortality rate if not promptly treated.

Erdheim-Chester Disease: A rare form of non-Langerhans cell histiocytosis characterized by the presence of granulomas and histiocytic infiltration in various organs, including the lungs, bones, and kidneys.
Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis): A form of vasculitis characterized by asthma, eosinophilia, and the presence of necrotizing granulomas, particularly in the lungs and skin.
Necrotizing Sarcoid Granulomatosis: A rare variant of sarcoidosis characterized by necrotizing granulomas, which can mimic other forms of vasculitis or granulomatous disease.