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Hepatic granulomas 

Hepatic granulomas

Chapter:
Hepatic granulomas
Author(s):

C.W.N. Spearman

, M.W. Sonderup

, and S.J. Saunders

DOI:
10.1093/med/9780199204854.003.152207_update_001

Update:

Description of hepatic manifestations of immune reconstitution inflammatory syndrome in HIV/AIDS.

Updated on 30 Nov 2011. The previous version of this content can be found here.
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date: 30 March 2017

Granuloma formation occurs when persistent antigenaemia or poorly degradable antigens, such as chemicals or toxins, provide an ongoing stimulus that results in the focal accumulation of activated lymphocytes and macrophages, with the macrophages undergoing epithelioid transformation.

The diagnosis of granulomatous hepatitis is usually made during the investigation of a systemic illness, often presenting as pyrexia of unknown origin. Serum liver transaminases are frequently normal, but alkaline phosphatase and γ‎-glutamyltransferase levels may be elevated. The histomorphology of the granuloma, their distribution in the liver and special stains, e.g. Ziehl–Neelsen for mycobacteria and methenamine silver for fungi, may yield a definite diagnosis.

The causes of hepatic granulomas vary depending on the patient population and country studied. In the developed world most cases are due to sarcoidosis, primary biliary cirrhosis or are drug-induced, whilst infectious causes such as mycobacterial infections, schistosomiasis and AIDS-related infections predominate in the developing world.

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