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Granulomatous Hepatitis with Miliary Mottling: A Rare Cause
Vinod Joshi1, Shubhra Jain1, Vinod Sharma1
1Department of Pulmonary Medicine, SMS Medical College, Jaipur, Rajasthan.
The Journal of the Association of Physicians of India
|July 20, 2019
Summary
Miliary mottling often suggests tuberculosis, but this case shows it can mimic other lung diseases. A man with tuberculosis-like symptoms was diagnosed with sarcoidosis after liver biopsy and improved with corticosteroids.
Area of Science:
- Pulmonology
- Hepatology
- Immunology
Background:
- Miliary mottling on chest imaging is a common sign of tuberculosis.
- Clinical presentations of tuberculosis can overlap with various other pulmonary conditions.
- Granulomatous inflammation in the liver can be associated with both infectious and non-infectious etiologies.
Observation:
- A 40-year-old male presented with symptoms suggestive of tuberculosis.
- Chest skiagram revealed miliary mottling.
- Histopathology of the liver demonstrated granulomatous hepatitis.
Findings:
- Despite initial suspicion of tuberculosis, the liver biopsy led to a final diagnosis of sarcoidosis.
- The patient showed clinical improvement following treatment with oral corticosteroids.
Implications:
- This case highlights the importance of considering sarcoidosis in the differential diagnosis of miliary mottling and granulomatous hepatitis.
- It underscores the need for thorough histopathological evaluation to differentiate between tuberculosis and sarcoidosis.
- Corticosteroid therapy can be effective for sarcoidosis presenting with hepatic involvement.
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