Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

646 Granuloma Annulare Granulomatous Liver Disease

complications and prognosis

■Spontaneous resolution occurs within 2 years in 50% of affected per-

sons.

Granulomatous Liver Disease...........................

AIJAZ AHMED, MD

history & physical

History

■Major causes: TB, sarcoidosis, PBC, Crohn disease, foreign body,

drugs, neoplasms (Hodgkin lymphoma), misc infections

■Cause unknown in 50% of cases

Signs & Symptoms

■Abdominal pain, weight loss, fatigue, fever of unknown origin, hep-

atomegaly, splenomegaly

tests

Basic Blood Tests

■Alkaline phosphatase; normal to mildly – AST & ALT

Specific Diagnostic Test

■Liver biopsy

differential diagnosis

■Various causes of hepatic granulomas vs idiopathic granulomatous

hepatitis

management

What to Do First

■Avoid/discontinue causative agent if known (drug), treat underlying

infections, steroids in sarcoidosis

specific therapy

■No proven therapy for idiopathic granulomatous hepatitis; may

improve/resolve spontaneously & w/ steroid or methotrexate use

follow-up

■Clinical & lab

complications and prognosis

■Rarely progresses to cirrhosis & portal hypertension