Granulomatous inflammation of the liver in children

Granulomatous inflammation of the liver (granulomatous hepatitis) is a rare condition characterized by granulomas within the hepatic parenchyma. It may result from infectious causes (tuberculosis and Epstein–Barr virus infection) as well as noninfectious etiologies (drug-induced liver injury and systemic diseases). Its diagnosis and management require a multidisciplinary approach. Four pediatric patients with granulomatous liver involvement underwent abdominal ultrasonography, computed tomography, magnetic resonance imaging, and liver trephine biopsy with subsequent histological and immunohistochemical examination. In addition, polymerase chain reaction and serological testing were performed to identify infectious agents. All patients demonstrated multiple focal hepatic lesions. In two of them, Epstein–Barr virus DNA was detected, and histological analysis confirmed granulomas composed of epithelioid cells and giant cells. Following biopsy and symptomatic therapy, a reduction in hepatic lesions was observed, with complete resolution documented after 3 months. Granulomatous hepatitis is frequently asymptomatic and requires comprehensive diagnostic evaluation, including liver biopsy. Treatment aimed at eliminating the underlying cause leads to a favorable outcome. Early diagnosis and timely therapy are essential to prevent progression to hepatic fibrosis and cirrhosis.