Liver & intrahepatic bile ducts

Noninfectious hepatitis

Granulomatous hepatitis-noninfectious

Topic Completed: 1 May 2015

Minor changes: 11 June 2021

Copyright: 2002-2021,, Inc.

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

Anthony W.H. Chan, M.B.Ch.B.
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Cite this page: Chan A. Granulomatous hepatitis-noninfectious. website. Accessed October 23rd, 2021.
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
  • 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

Contributed by Anthony W.H. Chan, F.R.C.P.A.

Fibrin ring granuloma

Classical Hodgkin lymphoma

Trifluoperazine induced liver injury

Primary biliary cirrhosis

In sarcoidosis

Lipogranuloma in nonalcoholic fatty liver disease

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