Hepatic Granulomatosis and Sarcoidosis

Hepatic granulomatosis found during study of patients with unexplained fever or fatigue was in the past often attributed to tuberculosis and has recently been described as a syndrome of unknown cause. Study of 30 patients with normal chest roentgenograms and noncaseating hepatic granulomas indicates the importance of biopsies from other tissues. A diagnosis of sarcoidosis appeared justified in nine patients by the demonstration of extra-abdominal granulomas or prior hilar adenopathy. Seven patients with similar clinical features and demonstration of granulomas in spleen or abdominal lymph nodes probably had sarcoidosis, and other patients may have had this disease. The Kveim reaction, positive in only 2 of 27 patients tested, has little value in excluding sarcoidosis. Corticosteroid treatment was consistently effective in control of symptoms, but serial biopsies often showed little effect on the hepatic lesions.