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hepatic fibrin-ring granuloma
Tuesday 2 February 2010
Fibrin ring granulomas are rare lesions whose pathophysiology has remained somewhat elusive. It has been suggested that these peculiar lesions are related to focal vasculitis with endothelial injury and deposition of immune complexes. Fibrin ring granulomas have been described in Q fever; in viral infections such as cytomegalovirus, Epstein-Barr virus, and hepatitis A virus; and in other conditions.
Fibrin-ring granulomas in liver biopsy specimens of acute hepatitis are a rare and unspecific finding.
Possible causes include Hodgkin lymphoma, drug reactions, rheumatic diseases
and infections.
Pathogens associated with fibrin-ring granulomas are Coxiella burnetii, Mycobacterium tuberculosis and Leishmania sp.
Leishmaniasis can be reactivated in immunocompromised patients years after
primary infection. Typical clinical symptoms may then be absent, leading to a delay in diagnosis and more severe course of infection.
Due to human migration and increased tourism, visceral leishmaniasis may become more common in non-endemic areas.
Etiologies
infections
- Coxiella burnetii
- Rickettsia sp.
- Leptospira sp.
- Salmonella sp.
- CMV
- HIV
- EBV
- HCV (17520520)
- Mycobacterium tuberculosis
hepatic fibrin-ring checkpoint inhibitor-induced hepatitis (27792061)
Hodgkin disease
drug toxicity
- allopurinol
Synopsis
granulomatous hepatitis with fibrin-ring granulomas
References
Hepatitis with fibrin-ring granulomas. Khanlari B, Bodmer M, Terracciano L, Heim MH, Fluckiger U, Weisser M. Infection. 2008 Aug;36(4):381-3. PMID: 17926000
Fibrin ring granuloma in chronic hepatitis C: virus-related vasculitis and/or immune complex disease? Glazer E, Ejaz A, Coley CJ 2nd, Bednarek K, Theise ND. Semin Liver Dis. 2007 May;27(2):227-30. PMID: 17520520
Marazuela M, Moreno A, Yebra M, Cerezo M, Gomez-Gesto M, Vargas JA: Hepatic fibrin-ring granulomas: a clinicopathologic study of 23 patients. Hum Pathol 1991; 22: 607–613.
Stricker BH, Blok AP, Babany G, Benhamou JP: Fibrin ring granulomas and allopurinol. Gastroenterology 1989; 96: 1199–1203.v
