Liver & intrahepatic bile ducts
Noninfectious hepatitis
Granulomatous hepatitis-noninfectious

Topic Completed: 1 May 2015

Minor changes: 28 July 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Granulomatous hepatitis[TI] liver full text[sb]

Anthony W.H. Chan, F.R.C.P.A.
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Cite this page: Chan A. Granulomatous hepatitis-noninfectious. website. Accessed September 20th, 2020.
Definition / general
Case reports
Microscopic (histologic) description
  • Morphology (epithelioid, suppurative, fibrin ring or lipogranuloma) may suggest underlying etiology
  • Epithelioid granuloma: infectious and noninfectious (e.g. primary biliary cirrhosis, drug induced liver injury, foreign body reaction, sarcoidosis, Crohn's disease, chronic granulomatous disease, lymphoma)
  • Caseating epithelioid granuloma: typically associated with infections, most notably tuberculosis
  • Suppurative granuloma (granulomatous inflammation with stellate abscess formation or suppurative inflammation): bartonellosis, yersinosis, tularemia, listerosis, melioidosis, actinomycosis and fungal infection (see granulomatous hepatitis - infectious)
  • Fibrin ring granuloma (also known as doughnut granuloma; central fat globule surrounded by a circumferential rim of fibrin and histiocytes): originally pathognomonic for Q fever (Coxiella burnetii); now considered as nonspecific and could be associated with mycobacterial infection, staphylococcal bacteremia, leishmaniasis, toxoplasmosis, cytomegalovirus, Epstein-Barr virus, acute hepatitis A, systemic lupus erythematosus, allopurinol toxicity and lymphoma
  • Lipogranuloma (central fat globule surrounded by histiocytes without fibrin ring): alcoholic and nonalcoholic fatty liver disease, mineral oil
Microscopic (histologic) images
Images contributed by Anthony W.H. Chan, FRCPA:
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Fibrin ring granuloma

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Classical Hodgkin lymphoma

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Trifluoperazine induced liver injury

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Primary biliary cirrhosis

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In sarcoidosis

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Lipogranuloma in nonalcoholic fatty liver disease

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