Causes of granulomas in the liver:
(1) sarcoidosis
(2) malignant lymphoma
(3) carcinoma (extrahepatic)
(4) primary biliary cirrhosis (PBC)
(5) primary sclerosing cholangitis (PSC)
(6) medications (over 40 drugs implicated)
(7) chemical and/or toxin exposure
(8) status post BCG immunization
(9) tuberculosis and other mycobacterial infection
(10) deep fungal infection (histoplasmosis, other)
(11) Rickettsial infection (Q fever, other)
(12) Lyme’s disease
(13) viral infections (EBV, CMV, etc)
(14) parasites (toxoplasmosis, etc)
(15) bacterial infection (brucellosis, bartonellosis, etc)
(16) chlamydia
(17) lipogranulomas (from endogenous fat or mineral oil
(18) autoimmune diseases (RA, SLE, polyarteritis, etc)
(19) Crohn’s disease
(20) foreign body reaction
If no cause is found then the patient is said to have idiopathic granulomatous hepatitis. Some patients classified as having idiopathic granulomas will have a cause identified over time.
