Hepatic granulomas are abnormal small clumps of cells that form when certain disorders are present.

Granulomas themselves usually cause no problems, but the disorders that cause them may. Granulomas have many causes. The most common are drugs, infections, and certain disorders that affect the whole body. Tuberculosis and schistosomiasis (which are infections) and sarcoidosis (see Interstitial Lung Diseases: Sarcoidosis) are common causes. Granulomas can occur in primary biliary cirrhosis (see Fatty Liver, Cirrhosis, and Related Disorders: Primary Biliary Cirrhosis).

Granulomas may form when cells of the immune system gather to respond to irritants or to defend the body against foreign substances in the liver. Inflammation can result. If it is widespread, the liver may malfunction. Rarely, fibrous tissue and portal hypertension develop.

Symptoms

Granulomas themselves typically cause no symptoms. The liver may enlarge slightly, and mild jaundice (a yellowish discoloration of the skin and the whites of the eyes) may develop. Other symptoms, if they develop, result from the disorder causing the granulomas. Granulomas caused by sarcoidosis may disappear spontaneously or persist for years with out causing any noticeable symptoms.

Idiopathic granulomatous hepatitis is a rare disorder of unknown cause. It causes granulomas, fever, muscle aches, and fatigue. These symptoms often occur intermittently for years.

Diagnosis

Doctors ask questions about drug use and other disorders that could cause granulomas. Doctors also do blood tests to evaluate liver function and imaging tests, such as ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). However, the results are inconclusive. Biopsy (removal of a small sample of liver tissue with a needle for examination under a microscope) is needed to confirm the diagnosis. Other tests, such as cultures, may be needed to identify the cause.

Treatment

The underlying disorder is treated. Stopping a drug or treating an infection usually causes the granulomas to disappear. Sometimes corticosteroids are used to treat sarcoidosis, but whether they prevent the disorder from progressing is uncertain.

Last full review/revision September 2007 by Steven K. Herrine, MD