Cyclophosphamide therapy of idiopathic hepatic granulomatosis

A 50-year-old woman presented with idiopathic hepatic granulomatosis and autoimmune hemolytic anemia. Splenectomy corrected the anemia, and the liver disorder responded to prednisone. However, her liver disease relapsed on four occasions when prednisone was tapered, including three episodes when hepatic granulomatosis was proven by biopsy. Cyclophosphamide therapy allowed prednisone withdrawal, and she has remained in clinical and biochemical remission for two years on a low dose of the drug.