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
Distinction of these is not always possible, although in ALL cases, the following stains should be performed to rule out infection:
For fungal organisms
: Grocott-Gomori methenamine-silver stain (GMS) OR digested periodic acid-Schiff (PAS) ANDFor acid-fast organisms
: Ziehl-Nielsen OR 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.