Liver granuloma
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Synopsis
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%).
Codes
ICD10CM:K75.3 – Granulomatous hepatitis, not elsewhere classified
SNOMEDCT:
714253009 – Hepatic granuloma
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Etiology:- Infectious etiologies (tuberculosis, blastomycosis, cryptococcosis, histoplasmosis, schistosomiasis, actinomycosis, brucellosis, cat-scratch fever, syphilis, other mycobacterial infections, tularemia, Q fever)
- Chronic granulomatous disease
- Autoimmune disease (sarcoidosis, primary biliary cirrhosis)
- Malignancy (eg, Hodgkin lymphoma)
- Drug side effects (allopurinol, phenylbutazone, quinidine, sulfonamides)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/06/2018
Last Updated:02/06/2018
Last Updated:02/06/2018