Granulomatous Liver Disease

In the United States, the majority of patients with granulomatous liver disease do not have an identifiable cause. When a specific diagnosis can be made, therapy should be directed at eradicating the cause. A plan of management must recognize the drug history and nationality of the patient, chest radiograph, slit lamp examination of the eyes, skin tests, special stains of liver biopsies, and serum antibodies. In those patients for whom a specific diagnosis cannot be established, the use of corticosteroids requires that the patient have a clinical justification for treatment or manifest important changes in findings of liver biopsies. Patients selected for steroid treatment should be subjected to close laboratory monitoring, and the decision to continue therapy should be based on objective parameters. Treatment of steroid-resistant disease might require methotrexate, chloroquine, cyclosporine, azathioprine, or ursodeoxycholic acid.