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. Other laboratory abnormalities depend on the specific cause. Liver biopsy is essential for diagnosis and should be considered whenever a systemic granulomatous disorder is suspected, even in the absence of apparent liver involvement. Prognosis and Treatment Hepatic granulomas caused by drugs or infection regress completely after appropriate therapy.
Treatment depends on the cause.
When the cause is unknown, it is generally best to follow up the patient rather than to 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 recurrent fever in patients with idiopathic granulomatous hepatitis. All rights reserved.