Granulomatous hepatitis, deciphering an elusive spectrum: a clinical case-based approach

Authors

DOI:

https://doi.org/10.22516/25007440.980

Keywords:

Granuloma, Hepatitis, Sarcoidosis, Tuberculosis, Fever of unknown origin

Abstract

Granulomatous hepatitis is a well-defined histopathologic entity characterized by aggregates of modified macrophages (epithelioid in appearance) and other inflammatory cells that accumulate after persistent exposure to antigens. It induces a cellular immune response mediated by the release of various cytokines (including interferon-gamma [INF-γ], tumor necrosis factor-alpha [TNF-α], and interleukin 12 [IL-12]) that stimulate mononuclear cell fusion, culminating in the formation of multinucleated giant cells with a surrounding border of lymphocytes and fibroblasts. It represents between 2% and 15% of all pathological liver studies, usually during an infiltrative or cholestatic biochemical pattern. A practical approach is proposed based on a challenging clinical case of a patient with a fever of unknown origin in an intermediate incidence area for tuberculosis, such as Colombia.

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Author Biographies

Julián Rondón Carvajal, Universidad de Antioquia

Médico y cirujano, especialista en Medicina Interna. Médico internista – Docente ocasional, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.

Óscar Andrés Reyna Carrasco, Universidad Libre de Colombia

Médico y cirujano, especialista en Medicina Interna. Médico internista – Docente ocasional, departamento de Medicina Interna, Facultad de Ciencias de la Salud, Universidad Libre de Colombia – Seccional Cali. Cali, Colombia.

 

Melissa Fernanda Lara Viáfara, Universidad Libre de Colombia

Médico y cirujano. Médico residente de medicina interna, departamento de medicina interna, Facultad de Ciencias de la Salud, Universidad Libre de Colombia – Seccional Cali. Cali, Colombia.

 

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Figure 2. Liver biopsy. A. The sections show the liver parenchyma with numerous small granulomas, which are frequent in the periportal region, consisting of multiple compact aggregates of epithelioid cells with little lymphocytic infiltrate around them, without necrosis (hematoxylin and eosin, 100x); no fungi or mycobacteria were observed in the PAS and Ziehl-Neelsen stains (yellow arrow). B. In the reticulum stain, a cuff of fibrosis is noted around the granulomas (black arrow). The morphological findings correspond to granulomatous hepatitis (silver salt stain, 40x). Courtesy of Dr. María Mercedes Mendoza, pathologist, Hospital Militar Central. Bogotá, Colombia.

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Published

2023-09-27

How to Cite

Rondón Carvajal, J., Reyna Carrasco, Óscar A., & Lara Viáfara, M. F. (2023). Granulomatous hepatitis, deciphering an elusive spectrum: a clinical case-based approach. Revista Colombiana De Gastroenterología, 38(3), 383–391. https://doi.org/10.22516/25007440.980

Issue

Vol. 38 No. 3 (2023): July - September

Section

Case report

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