Acute liver injury as a manifestation of granulomatous hepatitis: diagnostic challenges

Granulomatous hepatitis is a rare clinical entity characterized by granuloma formation in the liver, with a diverse etiology that includes infectious, autoimmune, and malignant causes. This case report details a 35-year-old male presenting with jaundice, abdominal pain, and malaise. Laboratory findings showed features of acute liver injury, with elevated liver enzymes and bilirubin, while imaging studies revealed hepatomegaly and lymphadenopathy. A liver biopsy confirmed non-caseating granulomas, with negative results for infectious and autoimmune etiologies. Further investigations, including a bone marrow biopsy, identified Hodgkin's lymphoma, establishing the diagnosis of granulomatous hepatitis as a paraneoplastic manifestation. The patient was referred for oncological treatment, underscoring the critical role of liver biopsy and histopathological evaluation in diagnosing granulomatous hepatitis of unclear origin. This case highlights the diagnostic complexities and the need for a multidisciplinary approach in identifying systemic malignancies presenting with hepatic manifestations.