A liver granuloma is a histologic entity that is important in the diagnosis of a number of liver pathologies. Granulomas in the liver rarely cause structural hepatic injury, but they can be clues to an underlying systemic disorder that needs to be identified. A granuloma is an organized immune response composed of epithelioid macrophages, multinucleated giant cells, and lymphocytes.

Liver granulomas are most often caused by infection (tuberculosis, fungi), autoimmune disease (sarcoidosis, primary biliary cirrhosis), malignancy (Hodgkin lymphoma), or drug side effects (allopurinol). Sarcoidosis and tuberculosis are the most common causes of liver granulomas.

Symptoms and treatment of a liver granuloma vary with underlying etiology. A variety of proteins may be secreted by cells in granulomas, a few of which are characteristic of certain diseases (eg, elevated serum angiotensin-converting enzyme [ACE] suggests a diagnosis of active sarcoidosis). The presence of granulomas may only be identified through the workup of asymptomatic liver enzyme elevations or hepatomegaly on examination. In some patients, the cause of hepatic granulomas cannot be identified (10%-30%).