Granulomatous Hepatitis

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Granulomatous Hepatitis

Granulomas can be found in the liver due to a variety of causes. The most common among these are:
  • Medication reactions
  • Infections with fungal or acid-fast organisms
  • Sarcoidosis
Distinction of these is not always possible, although in all cases, the following stains should be performed to rule out infection.
For fungal organisms (one of the following):
  • Grocott-Gomori methenamine-silver stain (GMS)
  • Digested periodic acid-Schiff (PAS)
AND
For acid-fast organisms (one of the following):
  • Ziehl-Nielsen
  • Fite stain
Unfortunately, these stains have a relatively high false negative rate, so negative stains should be correlated with clinical and culture findings before excluding an infection.