Granulomatous hepatitis and cholangitis associated with giardiasis.

Biopsy of the liver revealed granulomas in portal tracts and cholangitis in a woman with chronic diarrhea, weight loss, fever, hypoalbuminemia, and anemia attributed to giardiasis. Eradication of Giardia resulted in rapid improvement of symptoms and resolution of histologic changes on a second biopsy of the liver after 3 mo. The patient had serum immunoglobulin levels that were either normal (IgG, IgM) or elevated (IgA), detectable levels in serum of anti-Giardia antibody, and an HLA phenotype (B12, B27) known to be associated with prolonged giardiasis.