Pathophysiology Granuloma formation is incompletely understood. The lesions are regarded as the host's attempt to protect against poorly soluble exogenous or endogenous irritants. Sometimes an aggressive inflammatory response around the granulomas ensues, resulting in progressive hepatic fibrosis and portal hypertension. This is typical of schistosomiasis and occasionally occurs in extensive sarcoidal infiltration. Symptoms and Signs Clinical features reflect the underlying cause.
History is critical in establishing a drug etiology.
Various systemic features may indicate sarcoidosis, collagen vascular disease, lymphoma, and other causes. Signs of primary liver disease are usually lacking, and hepatosplenomegaly is typically absent or mild except in schistosomiasis. In most cases, liver function tests are only mildly deranged, usually with a disproportionate elevation of alkaline phosphatase. Bilirubin levels are typically normal or only mildly elevated, unless hepatocellular injury coexists. A predominant cholestatic reaction suggests primary biliary cirrhosis, especially if long-standing.