We report a unique association of ruptured hepatocellular adenoma, focal nodular hyperplasia and granulomatous hepatitis in a young woman taking oral contraceptives. Diffuse granulomatous hepatitis was found in the liver parenchyma, which was associated with a large granulomatous mass of the left lobe and loco-regional granulomatous lymphadenitis. We cannot give a full explanation of the situation, which represented a challenge in the diagnosis and in the treatment of this patient.