Granulomatous liver disease



The most common causes of hepatic granulomas where primary biliary cirrhosis has been excluded are sarcoidosis, chronic liver disease, biliary tract disease, tuberculosis, Q fever, other infections, drug hepatotoxicity, neoplasms and idiopathic (Table 43.1).

TABLE 43.1 Causes of granulomas

Associated with pyrexia of unknown origin Sarcoidosis, tuberculosis (miliary and pulmonary, caseation important), atypical mycobacterium, Q fever, brucellosis, cat-scratch disease, mycoses, drugs, idiopathic granulomatous hepatitis
Human immunodeficiency virus (HIV) Mycobacterium avium complex, idiopathic, other mycobacteria, Mycobacterium tuberculosis, Cryptococcus, Histoplasma, medications (trimethoprim-sulfamethoxazole)
Infectious diseases Bacteria: actinomycosis, brucellosis, cat-scratch disease, listeriosis, syphilis, tularaemia, Whipple’s disease
Mycobacteria: tuberculosis, leprosy (lepromatous and tuberculoid)
Rickettsia: Q fever
Chlamydia: lymphopathia venereum, psittacosis
Fungi: aspergillosis, blastomycosis, candidiasis, cryptococcosis, histoplasmosis
Viruses: cytomegalovirus, Epstein-Barr virus, infectious mononucleosis
Parasites: amoebiasis, capillariasis, fascioliasis, schistosomiasis, toxoplasmosis, visceral leishmaniasis (kala-azar)
Hypersensitivity and immunological diseases Metals: beryllium, copper, gold
Hypogammaglobulinaemia, primary biliary cirrhosis, primary sclerosing cholangitis, systemic lupus erythematosus
Vascular diseases: disseminated visceral giant cell arteritis, polyarteritis nodosa, temporal arthritis, Wegener’s granulomatosis
Foreign materials Anthracotic pigments, barium, cement and mica dust; mineral oil—radiocontrast media, food additives; silica, suture material, talc
Neoplasms Hodgkin’s disease, non-Hodgkin’s lymphoma
Miscellaneous diseases Biliary tract obstruction, bile granulomas, chronic inflammatory bowel disease, eosinophilic gastroenteritis, jejunoileal bypass, porphyria cutanea tarda, sarcoidosis, idiopathic
Drugs Allopurinol, amiodarone, amoxicillin/clavulanic acid, chlorpromazine, chlorpropamide, diltiazem, gold salts, halothane, hydralazine, methyldopa, benzylpenicillin, phenoxymethylpenicillin, phenylbutazone, phenytoin, procainamide, quinidine, quinine, sulfonamides

Mar 29, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Granulomatous liver disease
Premium Wordpress Themes by UFO Themes