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Granulomatous Hepatitis


Presentation

  • We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy.[ncbi.nlm.nih.gov]
  • A 56 year old patient with scrub typhus infection having unusual presentation of hepatic injury resembling acute hepatitis is described.[ncbi.nlm.nih.gov]
  • In rare instances severe life-threatening complications occur in relation with BCG instillation immunotherapy that may involve multiple organs and have different presentations and require a high index of suspicion and clinical awareness in a wide range[ncbi.nlm.nih.gov]
  • An unusual case of a well-documented granulomatous hepatitis in secondary syphilis in a 47-year-old male is presented.[ncbi.nlm.nih.gov]
  • Disseminated infection with Bartonella spp with granulomatous hepatitis was diagnosed in a liver transplant recipient presenting with fever of unknown origin.[ncbi.nlm.nih.gov]
Pain
  • ) and back pain.[medicine.academic.ru]
  • We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy.[ncbi.nlm.nih.gov]
  • Others may have Loss of appetite Nausea and vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Jaundice, yellowing of skin and eyes Some forms of hepatitis are mild, and others can be serious.[icdlist.com]
  • Retrieved from " " Categories : Ailments of unknown cause Abdominal pain Rare diseases Monocyte- and macrophage-related cutaneous conditions Autoimmune diseases Disease stubs Hidden categories: Articles needing additional references from July 2014 All[en.wikipedia.org]
  • This is called referred pain.[huiskopenfrankrijk.eu]
Malaise
  • It also… … Medical dictionary Fever, undulant — An infectious disease due to the bacteria Brucella that characteristically causes rising and falling fevers, sweats, malaise, weakness, anorexia, headache, myalgia (muscle pain) and back pain.[medicine.academic.ru]
  • Several adverse events such as generalized symptoms, fever, malaise and fatigue are observed in a significant proportion of patients.[omicsonline.org]
  • Fever, malaise, and other systemic symptoms are the usual presenting manifestations of an infective etiology; prolonged FUO is especially common in TB and fungal infections. The history is critical in establishing a drug etiology.[hepatitiscentral.com]
  • Symptoms include enlarged liver and spleen, fever fatigue, malaise and an overall crappy feeling all the time. Did the Prednisone thing which only worked on high doses which gave me so many other problems it wasn't worth taking.[forums.prohealth.com]
Intermittent Fever
  • RESULTS: Five patients were identified to have the specific syndrome of high grade intermittent fever with jaundice and hepatomegaly with investigations revealing an intrahepatic cholestasis.[ncbi.nlm.nih.gov]

Workup

  • Assessment of these patients and a comprehensive workup for infectious agents or other causes revealed idiopathic GH confined to the liver in 50%, sarcoidosis with confirmed extrahepatic disease in 22%, drug-related GH in 6%, tuberculosis in 3%, and other[ncbi.nlm.nih.gov]
  • Litvinov, bip3{at}georgetown.edu Summary We describe a case of a 23-year-old woman with a history of Crohn's disease (CD), who initially presented with sepsis-like symptoms, subsequently developed severe cholestasis and following extensive inpatient workup[casereports.bmj.com]
  • Owing to the diverse prognostic and therapeutic implications, a detailed workup of all liver biopsies with granulomatous lesions is mandatory.[atmph.org]
Liver Enzymes Abnormal
  • Liver enzyme abnormalities improved after etanercept was discontinued. We suggest that etanercept was responsible for the development of granulomatous hepatitis.[ncbi.nlm.nih.gov]
  • Overall, 65 patients (74%) were symptomatic; the rest had only liver enzyme abnormalities. The mean duration of symptoms was 19.1 months.[ncbi.nlm.nih.gov]
  • Moreover, liver enzyme abnormalities were present before anti-tuberculous administration. Hemophagocytic syndrome was thought to be due to BCG, an immunomodulatory agent that is extensively used for treating superficial bladder carcinomas.[em-consulte.com]
Lymphocytopenia
  • We conclude that our patient's thrombocytopenia, neutropenia, and lymphocytopenia were caused by quinine-dependent antibodies and that these antibodies recognized cell lineage-specific epitopes.[ncbi.nlm.nih.gov]
Toxocara Canis
  • This report describes possible involvement of Toxocara canis in granulomatous hepatitis in three patients who presented with varied clinical features; two were being treated for other diagnoses until Toxocara serology became available.[ncbi.nlm.nih.gov]
Bartonella Henselae
  • Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis.[ncbi.nlm.nih.gov]

Treatment

  • Intravesical administration of Bacillus Calmette-Guérin is used as a treatment method in superficial bladder cancer. While it is generally well tolerated, serious side effects may develop.[ncbi.nlm.nih.gov]
  • We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis.[ncbi.nlm.nih.gov]
  • Prompt diagnosis and treatment with corticosteroids, anti-tuberculous agents and intravenous immunoglobulins led to a rapid recovery.[ncbi.nlm.nih.gov]
  • Surprisingly, it does not respond to antibiotic but to steroids treatment. A hypersensitivity mechanism has been implicated.[ncbi.nlm.nih.gov]
  • We described a 48-year-old female with chronic hepatitis C infection who developed granulomatous hepatitis following treatment with IFN-alpha. The granulomatous inflammation resolved after discontinuation of IFN-alpha treatment.[ncbi.nlm.nih.gov]

Prognosis

  • We conclude that patients with fever of unknown origin who are diagnosed as having idiopathic granulomatous hepatitis have an excellent prognosis, even the minority who require long-term corticosteroids.[ncbi.nlm.nih.gov]
  • Systemic disease, e.g. chronic granulomatous disease, Crohn's disease, sarcoidosis, systemic lupus erythematosus, IgG4 disease and other connective tissue disorders Idiopathic: 10 - 15% of all hepatic granulomas; a diagnosis of exclusion; excellent prognosis[pathologyoutlines.com]
  • Prognosis and Treatment Hepatic granulomas of infective or drug etiology regress completely after appropriate therapy.[hepatitiscentral.com]
  • Immunosuppressive drugs should be considered early, as the response to therapy makes prognosis favorable. Acknowledgments We would like to thank the entire team of the admitting unit, especially Dr. Malobika Bhattacharya, Dr. Ashish Gupta, and Dr.[atmph.org]
  • Although the mechanism for the beneficial effects of BCG therapy remains unknown, this treatment reduces the rate of recurrence and improves the prognosis of these patients with a success rate of between 63 and 100% [ 4 ].[em-consulte.com]

Etiology

  • Attempts to define an exact etiology of the granulomatous hepatitis frequently does not yield a precise diagnosis, so that the physician must consider empiric treatment.[ncbi.nlm.nih.gov]
  • Although premortem evaluation failed to identify an etiologic agent, autopsy liver cultures produced smooth, rapid-growing mycobacterial colonies.[ncbi.nlm.nih.gov]
  • Drugs are an important etiologic factor. Several oral hypoglycemic agents are available for treatment of type II diabetes. Rosiglitazone, a thiazolidinedione, is a newer agent in this class.[ncbi.nlm.nih.gov]
  • Attempts to define an exact etiology of the fever of granulomatous hepatitis frequently do not yield a precise diagnosis.[ncbi.nlm.nih.gov]
  • Hepatic Granulomas Etiology The causes of liver granulomas are legion.[hepatitiscentral.com]

Epidemiology

  • Further epidemiological studies will be necessary to confirm this finding.[ncbi.nlm.nih.gov]
  • Tuberculosis was considered the most probable cause as per clinico-epidemiological data and antitubercular therapy (ATT) was started but there was poor response.[atmph.org]
  • Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 1995; 273: 220-6. Sheer TA, Coyle WJ. Gastrointestinal tuberculosis. Curr Gastroenterol Rep 2003; 5: 273-278.[latunisiemedicale.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Granuloma formation is incompletely understood. The lesions are regarded as a host attempt to protect against poorly soluble exogenous or endogenous irritants.[hepatitiscentral.com]
  • The pathophysiological mechanism of hemophagocytic syndrome remains poorly understood, but uncontrolled T-lymphocyte activation causes increased Th-1 cytokine secretion promoting macrophage activation.[em-consulte.com]
  • Pathophysiology A granuloma is a localized collection of chronic inflammatory cells with epithelioid cells and giant multinucleated cells. Caseation necrosis or foreign body tissue (eg, schistosome eggs) may be present.[merckmanuals.com]
  • The pathophysiological mechanism of the liver dysfunction in PMR remains unknown. Although giant cell arteritis is strongly associated with PMR, arteritis has never been reported in the liver biopsy of such a patient.[gastrohep.com]

Prevention

  • Prompt diagnosis and appropriate treatment could prevent further complications in the affected patients.[ncbi.nlm.nih.gov]
  • Vaccines can help prevent some viral forms.[icdlist.com]
  • Patients with progressive hepatic sarcoidosis may benefit from corticosteroid therapy, though it remains unclear whether this prevents hepatic fibrosis; corticosteroids are not indicated for most patients with sarcoidosis and should be given only if TB[hepatitiscentral.com]
  • Timely recognition and diagnosis of IGH is imperative as the disease responds well to immunosuppressants that can prevent permanent liver damage. We report a case of a young boy with IGH who was successfully treated with immunosuppressive therapy.[atmph.org]
  • Osteoarthritis prevent kneecap austin direct likely rapidshare cover disease. There is an overall increased female predilection.[huiskopenfrankrijk.eu]

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