Problem of differential diagnostics of granulomatous diseases remains actual till nowadays. Despite the informative of morphological and investigation it doesn't allow always to formulate correct diagnosis. Use of immunologic methods (test with allergen recombinant tuberculosis, Quantituberculosis test and ELISPOT) and immunohistochemistry frequently reveals. In the paper the difficulties of diagnostics of granulomatosis is substantiated. In the article introduced different clinical cases with differential diagnostics of tuberculosis and other different diseases with use this methods.