Granulomatous Liver Disease: Clinical Aspects

  • Willis C. Maddrey


The finding of hepatic granulomas may tantalize, challenge, frustrate, or guide the clinician to the correct diagnosis of a systemic illness. Hepatic granulomas are frequent, having been reported in 2– 10% of large series of liver biopsies.1–14 Granulomas represent a specialized (albeit nonspecific) type of inflammatory response of the mononuclear phagocytic (reticuloendothelial) system. The liver is a common site for granuloma formation most likely because of its rich blood supply and the large number of reticuloendothelial (Kupffer) cells. Granulomas may be circumscribed, nodular, well-delineated, and distinct from the surrounding parenchyma or found in areas of diffuse inflammation.11 The inciting agents that lead to granuloma formation may enter the liver via the hepatic artery, portal vein, or lymphatics.15 Most infectious agents that cause granulomas probably reach the liver through the blood. Granulomas are likely to occur whenever there is uptake by phagocytic cells of bacteria, fungi, parasites, or other pathogens that persist within the macrophages, thereby eliciting an inflammatory response that may be either an immunologic or nonimmunologic reaction.6, 11, 15


Liver Biopsy Primary Biliary Cirrhosis Acquire Immune Deficiency Syndrome Chronic Granulomatous Disease Hodgkin Disease 


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Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Willis C. Maddrey
    • 1
  1. 1.Department of MedicineJefferson Medical CollegePhiladelphiaUSA

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