A 16-year retrospective investigation of granulomatous liver injury in immunocompetent and immunocompromised patients at a tertiary care center
Abstract
Objectives: Recent data on the underlying causes of granulomatous liver injury in the United States remain limited. In this study, we provide updated tertiary care center data on the causes of hepatic granulomas and evaluate the use of histochemical and molecular diagnostics to identify infectious organisms.
Methods: We retrospectively reviewed 251 cases of hepatic granulomas (2009-2024) stratified by patient immune status. Additionally, we evaluated 6-year retrospective data from 2 institutions to determine the yield of broad-range molecular testing for infectious diseases.
Results: Causes of the 251 cases included idiopathic (31%), autoimmune disease (20%), steatohepatitis (19%), sarcoidosis (10%), infection (8%), and drug reaction (4%). A subset (9%) of idiopathic cases showed features highly suspicious for infection, but standard infectious stains were unrevealing, and none were initially sent for molecular testing. Retrospective evaluation of send-out pathogen molecular testing across both institutions revealed organism detection in 32% (12/37) and 50% (4/8) of highly suspicious cases, respectively. Increasing clinicopathologic suspicion correlated positively with successful molecular pathogen identification and inversely with false-positive contamination rates.
Conclusions: Molecular testing is frequently underused by pathologists in the workup of granulomatous hepatitis. Pathologists should proactively leverage molecular diagnostics to optimize clinical decision-making when standard histochemical stains are unrevealing.
Related
- Predictors of Response to Corticosteroid Therapy in Idiopathic Granulomatous Mastitis: A Retrospective Cohort Study of 176 Patients
- Case Report: Cytomegalovirus-associated granulomatous lung disease in an immunocompetent preterm infant
- Clinical application of vacuum sealing drainage in patients with idiopathic granulomatous mastitis
- Molecular detection of Acanthamoeba genotypes and Pneumocystis jirovecii in bronchoalveolar lavage specimens from immunocompetent patients with respiratory disorders
- Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic
BibTeX
@article{wang202616year,
title = {{A 16-year retrospective investigation of granulomatous liver injury in immunocompetent and immunocompromised patients at a tertiary care center}},
author = {Charles H Wang and Kathleen Byrnes and Gillian L Hale},
journal = {American Journal of Clinical Pathology},
year = {2026},
month = nov,
doi = {10.1093/ajcp/aqag114},
url = {https://doi.org/10.1093/ajcp/aqag114},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A 16-year retrospective investigation of granulomatous liver injury in immunocompetent and immunocompromised patients at a tertiary care center
AU - Charles H Wang
AU - Kathleen Byrnes
AU - Gillian L Hale
PY - 2026
DA - 2026/11/05
JO - American Journal of Clinical Pathology
DO - 10.1093/ajcp/aqag114
UR - https://doi.org/10.1093/ajcp/aqag114
AB - Objectives: Recent data on the underlying causes of granulomatous liver injury in the United States remain limited. In this study, we provide updated tertiary care center data on the causes of hepatic granulomas and evaluate the use of histochemical and molecular diagnostics to identify infectious organisms. Methods: We retrospectively reviewed 251 cases of hepatic granulomas (2009-2024) stratified by patient immune status. Additionally, we evaluated 6-year retrospective data from 2 institutions to determine the yield of broad-range molecular testing for infectious diseases. Results: Causes of the 251 cases included idiopathic (31%), autoimmune disease (20%), steatohepatitis (19%), sarcoidosis (10%), infection (8%), and drug reaction (4%). A subset (9%) of idiopathic cases showed features highly suspicious for infection, but standard infectious stains were unrevealing, and none were initially sent for molecular testing. Retrospective evaluation of send-out pathogen molecular testing across both institutions revealed organism detection in 32% (12/37) and 50% (4/8) of highly suspicious cases, respectively. Increasing clinicopathologic suspicion correlated positively with successful molecular pathogen identification and inversely with false-positive contamination rates. Conclusions: Molecular testing is frequently underused by pathologists in the workup of granulomatous hepatitis. Pathologists should proactively leverage molecular diagnostics to optimize clinical decision-making when standard histochemical stains are unrevealing.
SN - 0002-9173
SN - 1943-7722
ER -