What Do You Mean By Granulomatous Hepatitis? Causes & Treatment

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Are you totally new to the term Granulomatous Hepatitis? It is a health condition where granulomas are found in a human being’s liver. For the unknown, a granuloma is nothing but a small area of inflammation.

Causes Of Granulomatous Hepatitis

Generally, there are several causes associated with Granulomatous Hepatitis that may be infectious or non-infectious in nature. Of them, the most common causes include sarcoidosis, tuberculosis, primary biliary cholangitis (PBC), and drug-induced liver injury. In the United States, Granulomatous Hepatitis is attributed mainly to sarcoidosis and primary biliary cholangitis. However, if we take the global cases of infected patients, tuberculosis is found to be the most common cause.

Causes Of Granulomatous Hepatitis

1. Sarcoidosis - An inflammatory, multisystem granulomatous disease, sarcoidosis is commonly found among patients in the younger age group ie. those between 20 to 40 years of age. The second peak generally happens around the age of 60.

2. Primary biliary cholangitis - An autoimmune chronic liver disease, PBC was known by the name primary biliary cirrhosis in the past. It is commonly found among middle-aged women and its main feature includes destruction of the intrahepatic biliary ducts.

Other Causes

The other causes that lead to Granulomatous Hepatitis include

  • Many drugs, including oral hypoglycemic agents such as sulfonylureas, antibiotics including penicillin, allopurinol, sulfonamides, amiodarone, diltiazem and hydralazine, and antiepileptics such as phenytoin.
  • Being exposed to toxic substances including beryllium and silica is generally believed to be the cause of granulomatous hepatitis as they are associated with hypersensitivity reactions.
  • Health issues such as chronic hepatitis B and C infection, brucellosis, Bacille Calmette-Guerin (BCG) therapy, leprosy, coccidioidomycosis, histoplasmosis, schistosomiasis, lymphoma, amebic liver abscess, and malignant granuloma.
  • Some other causes include talc, barium, and silicone from therapeutic and diagnostic procedures.

Symptoms Of Granulomatous Hepatitis

Many people who are affected with Hepatic granulomas are asymptomatic. Thus, to diagnose the condition, it is quite necessary to perform a thorough history and physical examination.

However, those with symptoms such as abdominal pain and tenderness, especially in the right upper quadrant, hepatomegaly, fever of unknown origin, or mild transaminitis have a chance of being diagnosed with Hepatic granulomas. Also note that some of the constitutional symptoms such as prolonged fevers, chills, night sweats, weight loss, myalgias, anorexia, and arthralgias are common in the case of diseases such as tuberculosis and sarcoidosis.

Diagnosis

  • Some of the tools used in diagnosing Granulomatous Hepatitis include erythrocyte sedimentation rate, complete blood count with differential especially for the eosinophil count, comprehensive metabolic panel, C-reactive protein, and prothrombin time/international normalized ratio.
  • CT, MRI, or ultrasonography, the most commonly used imaging tests are found to be sensitive in the visualization of liver lesions.
  • Fine-needle liver biopsy is another pivotal diagnostic tool. However, it may be hard to distinguish between the various etiologies.

Possible Treatments For Granulomatous Hepatitis

  • In the treatment of granulomatous hepatitis, the underlying cause should be taken into consideration. Patients with asymptomatic, incidental, or idiopathic granulomas need to be monitored with regular follow-up sessions and/or liver function tests.
  • Patients with symptomatic granulomatous hepatitis whose etiology is not sure need to consult with a hepatology specialist.
  • Among people with symptomatic idiopathic granulomatous hepatitis, the majority of them respond well to corticosteroids. However, it is necessary to confirm that the patient is not having tuberculosis before putting him/her on immunosuppression with corticosteroids
  • In the case of Glucocorticoid therapy, 20 to 40 mg of prednisone is administered daily and the dosage is gradually reduced over a period of 4 to 8 weeks. If necessary, a second course may be given.
  • There are some patients for whom corticosteroids are not preferred or not recommended for use. In such cases, the alternative drugs would be methotrexate and infliximab.
  • It happens that in certain cases patients do not respond to corticosteroids. The next step would be checking the possibility of them being infected with atypical infections, lymphoma, or other malignancies. 

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Conclusion

Hope the article unravels the lesser-known aspects of granulomatous hepatitis. However, it is to be noted that depending on the severity, the disease may progress to fibrosis, cirrhosis, or portal hypertension. Thus timely and suitable therapy is necessary to stop the occurrence of fatal infection or hepatic dysfunction. In the case of some patients, lifelong therapy may also be required.

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Dr. David G Kiely is a distinguished Medical Reviewer and former General Medicine Consultant with a wealth of experience in the field. Dr. Kiely's notable career as a General Medicine Consultant highlights his significant contributions to the medical field.

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