Granulomatous hepatitis.

According to the literature on the subject, hepatic granulomas are present in 2.4%-10% of the liver tissue specimens examined in general hospitals. The pathogenesis and pathological importance of these lesions remain unclear in many cases. Hepatic granulomas have been associated with a wide variety of diseases, among which sarcoidosis, followed by tuberculosis, figure most prominently. The etiology remains undetermined in less than or equal to 36% of reported cases. In some instances the lesions are found by chance, and in other cases they are associated with a prolonged course of fever of undetermined origin, which may or may not resolve spontaneously. In the present article, the histopathogenesis and appearance of these lesions are described; the associated diseases are reviewed with detailed emphasis on the clinical manifestations, pathology, and diagnosis of those diseases most commonly responsible for the lesions; and, finally, some comments are offered on the diagnostic work-up and controversial management of undiagnosed cases.