Hepatic granulomas in leprosy. Their relation to bacteremia

A clinicopathologic study of liver disease was conducted on 28 patients with leprosy who lived in Taiwan. None of the patients exhibited symptoms or signs of liver disease. Hepatic granulomas were found in 21 patients. Histologically, the infiltrates were epithelioid, foam cell, and histiocytic in type. Hepatic dysfunction was absent, except for mild sulfobromophthalein elevations in the severely infected cases. Hepatic granulomas correlated with the cutaneous reactions in lepromatous leprosy, but the association was poor for other stages of disease. Hepatic involvement varied with the severity of cutaneous infection and with the frequency and intensity of bacteremia. An estimated 1,000 to 10,000 acid-fast bacilli/ml of blood was required to generate the hepatic infiltrates.