Bilirubin levels are typically normal or only mildly elevated, unless concomitant hepatocellular injury coexists. A predominant cholestatic reaction suggests primary biliary cirrhosis, especially if long-standing. Other laboratory abnormalities depend on the specific cause. Diagnosis Liver biopsy is essential for diagnosis and should be considered whenever a systemic granulomatous disorder is suspected, even in the absence of apparent hepatic involvement. Prognosis and Treatment Hepatic granulomas of infective or drug etiology regress completely after appropriate therapy.
Treatment depends on the underlying etiology.
Without an etiologic diagnosis, it is generally best to follow the patient rather than blindly treat with antibiotics or other therapies. Antituberculous therapy may be justified in a patient with prolonged fever, a compatible clinical picture, and a downhill systemic course. Corticosteroids usually suppress the recurrent fevers in patients with the syndrome of idiopathic granulomatous hepatitis.