granulomatous hepatitis

Digital cases

 Case 107

Definition: Presence of hepatic granulomas in the liver.

Granulomas are uncommon in hepatitis C but can occur in patients treated with interferon. Talc granulomas can occur in intravenous drug users and can be detected by viewing under polarised light.

Other systemic granulomatous disease such as chronic metal toxicity (such as beryllium or copper) can also involve the liver.55 Finally, a study of granulomatous hepatitis cases over a 13-year period identified 11% as idiopathic.79 These cases can present with fever of unknown origin and generally respond favourably to steroids.

The granulomas can be present in the portal tracts or the parenchyma and lack necrosis.

In primary biliary cirrhosis, the granulomas are centred on the bile ducts.

Granulomas also can occur with other patterns of liver injury such as acute hepatitis, cholestasis or steatosis.

Elementary lesions:

 hepatic granulomas

• tuberculoid granuloma (epithelioid granuloma)
• macrophagic granuloma
• fibrin-ring granuloma

Etiology

 hepatitis C
 talc granulomas ( intravenous drug users)
 systemic granulomatous disease

• chronic metal toxicity (such as beryllium or copper)

 primary biliary cirrhosis (granulomas centred on the bile ducts)
 acute hepatitis
 cholestasis
 steatosis
 carbamazepine (Tegretol) (carbamazepine-induced granulomatous hepatitis)

See also

 Granulomas
 granulomatoses

• systemic granulomatosis

References

 Carbamazepine induced granulomatous hepatitis. Swinburn BA, Croxson MS, Miller MV, Crawford KB. N Z Med J. 1986 Mar 12;99(797):167. PMID: 3457299