2019, Number 3
<< Back Next >>
Gac Med Mex 2019; 155 (3)
Enfermedad granulomatosa hepática
Ortiz-Brizuela E, Azamar-Llamas D, Delgado-De la Mora J, Guerrero-Castillo JI, Martínez-Benítez B, Sifuentes-Osornio J
Language: Spanish
References: 82
Page: 266-275
PDF size: 589.99 Kb.
ABSTRACT
Granulomas are circumscribed lesions mainly composed of mononuclear cells that arise in response to poorly degradable
antigenic stimuli. They are found in 2-15 % of liver biopsies and the meaning of their finding can range from an incidental
phenomenon to the manifestation of a systemic disease of infectious, autoimmune or neoplastic origin. Clinical presentation
usually points at the underlying pathology; however, the list of associated conditions is extensive, and differs based on patient
epidemiological history and baseline characteristics. The most useful element for their study is a thorough medical history, with
an emphasis on recent trips, exposures and consumption of drugs or raw or exotic foods. Detailed histopathological analysis
may help identify the etiology. For example, the presence of epithelioid granulomas with caseous necrosis indicates tuberculosis
and, its absence, sarcoidosis; eosinophil abundance can be associated with drug reactions or parasitic infections; and
the presence of foreign bodies can be the cause of granulomatous liver disease (GLD). In this article, we describe the basic
clinical-pathological aspects of GLD, and provide a brief summary of the most common etiologies, with an emphasis on the
Latin-American region.
REFERENCES
Chensue SW. Chemokines in innate and adaptive granuloma formation. Front Immunol. 2013;4:43.
Coash M, Forouhar F, Wu CH, Wu GY. Granulomatous liver diseases: a review. J Formos Med Assoc. 2012;111:3-13.
Drebber U, Kasper HU, Ratering J, Wedemeyer I, Schirmacher P, Dienes HP, et al. Hepatic granulomas: histological and molecular pathological approach to differential diagnosis: a study of 442 cases. Liver Int. 2008;28:828-834.
Peddireddy V, Doddam SN, Ahmed N. Mycobacterial Dormancy systems and host responses in tuberculosis. Front Immunol. 2017;8:84.
Shaker Y, Samy N, Ashour E. Hepatobiliary schistosomiasis. J Clin Transl Hepatol. 2014;2:212-216.
Saxena R. Hepatic granulomas: differential diagnosis. En: Practical hepatic pathology: a diagnostic approach. EE. UU.: Saunders/Elsevier; 2011.
Almadi MA, Aljebreen AM, Sanai FM, Marcus V, Almeghaiseeb ES, Ghosh S. New insights into gastrointestinal and hepatic granulomatous disorders. Nat Rev Gastroenterol Hepatol. 2011;8:455-466.
Scriba TJ, Coussens AK, Fletcher HA. Human immunology of tuberculosis. Microbiol Spectr. 2016;4.
Dorhoi A, Reece ST, Kaufmann SH. For better or for worse: the immune response against Mycobacterium tuberculosis balances pathology and protection. Immunol Rev. 2011;240:235-251.
Guirado E, Schlesinger LS. Modeling the mycobacterium tuberculosis granuloma: the critical battlefield in host immunity and disease. Front Immunol. 2013;4:98.
Lagana SM, Moreira RK, Lefkowitch JH. Hepatic granulomas: pathogenesis and differential diagnosis. Clin Liver Dis. 2010;14:605-617.
Lamps LW. Hepatic granulomas: a review with emphasis on infectious causes. Arch Pathol Lab Med. 2015;139:867-875.
Ramachandran R, Kakar S. Histological patterns in drug-induced liver disease. J Clin Pathol. 2009;62:481-492.
Zhu H, Bodenheimer HC, Clain DJ, Min AD, Theise ND. Hepatic lipogranulomas in patients with chronic liver disease: association with hepatitis C and fatty liver disease. World J Gastroenterol. 2010;16:5065-5069.
Sartin JS, Walker RC. Granulomatous hepatitis: a retrospective review of 88 cases at the Mayo Clinic. Mayo Clin Proc. 1991;66:914-918.
Sanai FM, Ashraf S, Abdo AA, Satti MB, Batwa F, Al-Husseini H, et al. Hepatic granuloma: decreasing trend in a high-incidence area. Liver Int. 2008;28:1402-1407.
Ungprasert P, Crowson CS, Simonetto DA, Matteson EL. Clinical characteristics and outcome of hepatic sarcoidosis: a population-based study 1976-2013. Am J Gastroenterol. 2017;112:1556-1563.
Sabharwal BD, Malhotra N, Garg R, Malhotra V. Granulomatous hepatitis: a retrospective study. Indian J Pathol Microbiol. 1995;38:413-416.
Wainwright H. Hepatic granulomas. Eur J Gastroenterol Hepatol. 2007;19:93-95.
Dourakis SP, Saramadou R, Alexopoulou A, Kafiri G, Deutsch M, Koskinas J, et al. Hepatic granulomas: a 6-year experience in a single center in Greece. Eur J Gastroenterol Hepatol. 2007;19:101-104.
Gaya DR, Thorburn D, Oien KA, Morris AJ, Stanley AJ. Hepatic granulomas: a 10 year single centre experience. J Clin Pathol. 2003;56:850-853.
Guglielmi V, Manghisi OG, Pirrelli M, Caruso ML. [Granulomatous hepatitis in a hospital population in southern Italy]. Pathologica 1994;86:271-8.
McCluggage WG, Sloan JM. Hepatic granulomas in Northern Ireland: a thirteen year review. Histopathology. 1994;25:219-228.
Satti MB, Al-Freihi H, Ibrahim EM, Abu-Melha A, Al-Ghassab G, Al- Idrissi HY, et al. Hepatic granuloma in Saudi Arabia: a clinicopathological study of 59 cases. Am J Gastroenterol. 1990;85:669-674.
Mert A, Ozaras R, Bilir M, Tahan V, Cetinkaya A, Yirmibescik S, et al. The etiology of hepatic granulomas. J Clin Gastroenterol 2001;32:275-6.
Geramizadeh B, Jahangiri R, Moradi E. Causes of hepatic granuloma: a 12-year single center experience from southern Iran. Arch Iran Med. 2011;14:288-289.
Knox TA, Kaplan MM, Gelfand JA, Wolff SM. Methotrexate treatment of idiopathic granulomatous hepatitis. Ann Intern Med. 1995;122:592-595.
Carey EJ, Ali AH, Lindor KD. Primary biliary cirrhosis. Lancet. 2015; 386:1565-1575.
Rodríguez-Lugo DA, Coronado-Tovar JJ, Solano-Villamarin GA, Otero- Regino W. Primary biliary cholangitis. Part 1. State of the art, epidemiology, physiopathology and clinical manifestations. Rev Gastroenterol Peru. 2017;37(4):357-364.
Aguilar-Nájera O, Velasco-Zamora JA, Torre A. Overlap syndromes of autoimmune hepatitis: diagnosis and treatment. Rev Gastroenterol Mex. 2015;80:150-159.
Turhan N, Kurt M, Ozderin YO, Kurt OK. Hepatic granulomas: a clinicopathologic analysis of 86 cases. Pathol Res Pract. 2011;207:359-365.
Global tuberculosis report 2017. Suiza: World Health Organization; 2017.
Chaudhary P. Hepatobiliary tuberculosis. Ann Gastroenterol. 2014; 27:207-211.
Torres-González P, Cervera-Hernández ME, Martínez-Gamboa A, García- García L, Cruz-Hervert LP, Bobadilla-Del Valle M, et al. Human tuberculosis caused by mycobacterium bovis: a retrospective comparison with mycobacterium tuberculosis in a Mexican tertiary care centre, 2000- 2015. BMC Infect Dis. 2016;16(1):657.
Kok KY, Yapp SK. Tuberculosis of the bile duct: a rare cause of obstructive jaundice. J Clin Gastroenterol. 1999;29:161-164.
Karaosmanoglu AD, Onur MR, Sahani DV, Tabari A, Karcaaltincaba M. Hepatobiliary tuberculosis: imaging findings. AJR Am J Roentgenol. 2016;207:694-704.
Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64:111-115.
Alcántara-Payawal DE, Matsumura M, Shiratori Y, Okudaira T, González R, López RA, et al. Direct detection of mycobacterium tuberculosis using polymerase chain reaction assay among patients with hepatic granuloma. J Hepatol. 1997;27:620-627.
Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63:e147-e195.
Del Campo-Rodríguez LE, Sifuentes-Osornio J. Opportunistic infections in the acquired immunodeficiency syndrome: the history in Mexico 20 years after the beginning of the epidemic. Rev Invest Clin. 2004;56:169-180.
Sonderup MW, Wainwright HC. human immunodeficiency virus infection, antiretroviral therapy, and liver pathology. Gastroenterol Clin North Am. 2017;46:327-343.
Poles MA, Dieterich DT, Schwarz ED, Weinshel EH, Lew EA, Lew R, et al. Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV). J Acquir Immune Defic Syndr Hum Retrovirol. 1996;11:170-177.
Lizardi-Cervera J, Soto-Ramírez LE, Poo JL, Uribe M. Hepatobiliary diseases in patients with human immunodeficiency virus (HIV) treated with non-highly active anti-retroviral therapy: frequency and clinical manifestations. Ann Hepatol. 2005;4:188-191.
Wilson EM, Rosenthal ES, Kattakuzhy S, Tang L, Kottilil S. Clinical laboratory testing in the era of directly acting antiviral therapies for hepatitis C. Clin Microbiol Rev. 2017;30:23-42.
Piñeirúa A, Sierra-Madero J, Cahn P, Guevara-Palmero RN, Martínez- Buitrago E, Young B, et al. The HIV care continuum in Latin America: challenges and opportunities. Lancet Infect Dis. 2015;15:833-839.
Araujo-Meléndez J, Sifuentes-Osornio J, Bobadilla-Del Valle JM, Aguilar- Cruz A, Torres-Ángeles O, Ramírez-González JL, et al. What do we know about Q fever in Mexico? Rev Invest Clin. 2012;64:541-5.
Dean AS, Crump L, Greter H, Schelling E, Zinsstag J. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6:e1865.
Hernández-Mora G, Ruiz-Villalobos N, Bonilla-Montoya R, Romero- Zúniga JJ, Jiménez-Arias J, González-Barrientos R, et al. Epidemiology of bovine brucellosis in Costa Rica: lessons learned from failures in the control of the disease. PLoS One. 2017;12 e0182380.
Borba MR, Stevenson MA, Goncalves VS, Neto JS, Ferreira F, Amaku M, et al. Prevalence and risk-mapping of bovine brucellosis in Maranhão State, Brazil. Prev Vet Med. 2012;110:169-176.
Poulsen KP, Hutchins FT, McNulty CM, Tremblay M, Zabala C, Barragan V, et al. Brucellosis in dairy cattle and goats in northern Ecuador. Am J Trop Med Hyg. 2014;90:712-715.
Costa PS, Brigatte ME, Greco DB. Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil. Rev Inst Med Trop Sao Paulo. 2006;48:5-9.
Geha R, Peters M, Gill RM, Dhaliwal G. Histology rings true. N Engl J Med. 2017;376:869-874.
Kersh GJ. Antimicrobial therapies for Q fever. Expert Rev Anti Infect Ther. 2013;11:1207-1214.
Rubach MP, Halliday JE, Cleaveland S, Crump JA. Brucellosis in low-income and middle-income countries. Curr Opin Infect Dis. 2013;26:404-412.
Young EJ, Hasanjani-Roushan MR, Shafae S, Genta RM, Taylor SL. Liver histology of acute brucellosis caused by Brucella melitensis. Hum Pathol. 2014;45:2023-2028.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1-e50.
Rammaert B, Desjardins A, Lortholary O. New insights into hepatosplenic candidosis, a manifestation of chronic disseminated candidosis. Mycoses. 2012;55 e74-e84.
Fortún J, Meije Y, Fresco G, Moreno S. Aspergillosis. Clinical forms and treatment. Enferm Infecc Microbiol Clin. 2012;30:201-208.
Chen L, Liu Y, Wang W, Liu K. Adrenal and hepatic aspergillosis in an immunocompetent patient. Infect Dis (Lond). 2015;47:428-432.
Piratvisuth T, Siripaitoon P, Sriplug H, Ovartlarnporn B. Findings and benefit of liver biopsies in 46 patients infected with human immunodeficiency virus. J Gastroenterol Hepatol. 1999;14:146-149.
Sifuentes-Osornio J, Corzo-León DE, Ponce-De León LA. Epidemiology of invasive fungal infections in Latin America. Curr Fungal Infect Rep. 2012;6:23-34.
Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016;63:e112-e146.
Heninger E, Hogan LH, Karman J, Macvilay S, Hill B, Woods JP, et al. Characterization of the histoplasma capsulatum-induced granuloma. J Immunol. 2006;177:3303-3313.
Sifuentes-Osornio J, Ponce-De León A. Diagnosis and treatment of non-European fungal infections. Curr Fungal Infect Rep. 2014;8:343-352.
Kothadia JP, Kone V, Giashuddin S. Granulomatous hepatitis: a rare primary manifestation of disseminated histoplasmosis in a renal transplant recipient. J Gastrointestin Liver Dis. 2017;26:114.
Niembro-Ortega MD, Martínez-Gamboa RA, Crabtree-Ramírez B, Martínez- Ayala P, Rangel-Cordero A, Velázquez-Zavala, NG, et al. PCR and urine antigen for diagnosis of disseminated histoplasmosis in AIDS patients. Poster session presented at: Conference on retroviruses and opportunistic infections. EE. UU.: 2018.
Ozaras R, Tahan V, Mert A, Uraz S, Kanat M, Tabak F, et al. The prevalence of hepatic granulomas in chronic hepatitis C. J Clin Gastroenterol. 2004;38:449-452.
Snyder N, Martínez JG, Xiao SY. Chronic hepatitis C is a common associated with hepatic granulomas. World J Gastroenterol. 2008;14: 6366-6369.
Tahan V, Ozaras R, Lacevic N, Ozden E, Yemisen M, Ozdogan O, et al. Prevalence of hepatic granulomas in chronic hepatitis B. Dig Dis Sci. 2004;49:1575-1577.
Harada K, Minato H, Hiramatsu K, Nakanuma Y. Epithelioid cell granulomas in chronic hepatitis C: immunohistochemical character and histological marker of favourable response to interferon-alpha therapy. Histopathology. 1998;33:216-221.
Noya O, Katz N, Pointier JP, Theron A, De Noya BA. Schistosomiasis in America. En: Franco-Paredes C, Santos-Preciado JI, editores. Neglected tropical diseases - Latin America and the Caribbean. Austria: Springer; 2015.
Francolugo-Vélez VA ZAJ. Infección del tracto urinario por Schistosoma haematobioum. Un caso en Cuernavaca, Morelos, México. Rev Mex Urol. 2010;70:187-192.
Avalos D, Nimeh W, Varela G. A case of schistosomiasis haematobium diagnosed in Mexico in a patient from Egypt. Rev Inst Salubr Enferm Trop. 1963;23:45-54.
Kadin ME, Donaldson SS, Dorfman RF. Isolated granulomas in Hodgkin’s disease. N Engl J Med. 1970;283:859-861.
Ruiz-Argüelles GJ, Mercado-Díaz MA, Ponce-De León S, Ponce- De León S, Pérez-Tamayo R. Studies on lymphomata. III. Lymphomata, granulomata and tuberculosis. Cancer. 1983;52:258-262.
Carrillo-Pérez DL, Apodaca-Cháveza EI, Carrillo-Maravilla E, Mejía- Ávila M, Hernández-Oropeza JL, Reyes E, et al. Sarcoidosis: a single hospital-based study in a 24-year period. Rev Invest Clin. 2015; 67:33-38.
Purriel P, Navarrete E. Epidemiology of sarcoidosis in Uruguay and other countries of Latin America. Am Rev Respir Dis. 1961;84:155-161.
Iwai K, Oka H. Sarcoidosis. Report of ten autopsy cases in Japan. Am Rev Respir Dis. 1964;90:612-622.
Judson MA. Extrapulmonary sarcoidosis. Semin Respir Crit Care Med. 2007;28:83-101.
Syed U, Alkhawam H, Bakhit M, Companioni RA, Walfish A. Hepatic sarcoidosis: pathogenesis, clinical context, and treatment options. Scand J Gastroenterol. 2016;51:1025-1030.
Ishak KG, Zimmerman HJ. Drug-induced and toxic granulomatous hepatitis. Baillieres Clin Gastroenterol. 1988;2:463-480.
Zhang X, Ouyang J, Thung SN. Histopathologic manifestations of drug-induced hepatotoxicity. Clin Liver Dis. 2013;17:547-564.