Parameters which can differentiate patients with "idiopathic" from patients with lymphoma-induced liver granulomas

Part of the "idiopathic" liver granulomas prove finally to be caused by infection, sarcoidosis, or malignancy. We looked for the initial admission parameters which may differentiate the idiopathic from the malignancy related granulomas. Patients with idiopathic granulomatous hepatitis had smaller spleen than of lymphoma related granulomas (2.15 +/- 2 versus 9.5 +/- 4.8 cm below the costal margin, p less than 0.01), smaller liver (2.61 +/- 2 cm versus 6.5 +/- 4.0 cm, p less than 0.05), a lower percent of eosinophils (2.3 +/- 1.4 versus 6.2 +/- 3.5%, p less than 0.05) and unlike patients with lymphoma, their fever did not persist beyond 4 wk (p = 0.03). Indeed, if the fever remitted spontaneously, it was likely that a benign condition was responsible for the granulomas (p less than 0.025). If fever persisted (4 wk), a liver or a spleen extending more than 4 cm below the costal margin and 4% eosinophils were attributed 1 point each; a score of 2 points had a specificity of 80 and a 100% sensitivity in detecting patients with lymphoma related liver granulomas. It is concluded that the size of the liver and spleen, the percentage of eosinophils, and the persistence of fever may differentiate between patients with idiopathic- versus lymphoma-related granulomatous hepatitis.