Granulomas and Hepatitis C

Abstract

Hepatitis C (HCV) is associated with a number of characteristic histological features. A recent paper has identified an increased frequency of granulomas in resection specimens from cases of HCV. We have carried out a retrospective study of 155 cases of HCV to assess the frequency of granulomas in biopsy specimens. We had two control groups: 151 cases of hepatitis B (HBV) and 129 cases of alcohol induced liver disease. Granulomas were found in 14 cases of HCV (10%), three cases of HBV (2%) and three cases of alcohol induced liver disease (2%). Granulomas were significantly commoner in cases of HCV than in the other two groups. Of the 14 cases of HCV, the granulomas could be ascribed to another cause in seven cases. When the analysis was carried out, excluding those granulomas which could be ascribed to another cause, they were still significantly commoner in cases of HCV. We conclude that granulomas are more frequent in HCV but that in half of cases in which they are found another cause can be identified. This means that if granulomas are seen in association with hepatitis C another aetiology should be sought before ascribing them to HCV.

Hepatic granulomas: a 10 year single centre experience

“…Chronic HCV has only been recognised as a cause of hepatic granulomas since the availability of routine serological testing in 1991, and was therefore not described as a cause of hepatic granulomas in the previous large UK series. 4 7 8 10 Hepatic granulomas have been described in up to 10% of liver biopsies from HCV infected patients, [12][13][14][15] although the clinical relevance of this finding is unknown. 16 17 Thus, we expected that there would have been a smaller proportion of ''idiopathic'' cases in our series.…”

Granulomatous liver diseases: A review

“…12,38,67e70 Hepatitis B The data for hepatic granuloma formation in hepatitis B infection is limited. However, a study by Goldin and colleagues 67 reported hepatic granulomas in 2% (3/151) of patients with chronic hepatitis B infection. As with hepatitis C, it is imperative that other granulomatous diseases such as tuberculosis, brucellosis, sarcoidosis and drug reactions be excluded.…”

Chronic hepatitis C is a common associated with hepatic granulomas

“…Emile et al [9] found that the explants of 5 of 52 patients undergoing liver transplantation for cirrhosis from HCV had epithelioid granulomas, and none of these patients had evidence of any other diseases such as tuberculosis or sarcoidosis. Goldin et al [4] found in a retrospective study that there were granulomas in the liver biopsy specimens of 14/155 patients with HCV compared with only 3/151 with HBV and 3/129 with alcoholic liver disease. Yamamoto et al [6] found unexplained granulomas in 2/273 (0.73%) liver biopsies of patients with chronic HCV.…”

“…In some cases the granulomas are associated with a clinical picture which includes a high alkaline phosphatase and hepatomegaly; but these features are frequently absent. A significant percentage of liver biopsies performed today are for the staging of chronic hepatitis C. Granulomas have been reported with possible increased frequency in patients with hepatitis C with both mild disease as well as in explants [4][5][6][7][8] . It has been postulated that hepatitis C virus (HCV) may have a role in granuloma formation [9] .…”