Granulomatous liver disease

Chapter 43 GRANULOMATOUS LIVER DISEASE







CAUSES OF GRANULOMAS


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
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