Case 83: Hepatitis, autoimmune
28 year year old woman with history of fulminant hepatic failure three years prior, attributed to HELLP syndrome following cesarean section for placental abruption. Liver biopsy at the time revealed hepatic necrosis with microvesicular fatty change. The patient improved significantly on prednisone and cyclosporine. The patient now re-presents with pain.
CT: Granulomatous hepatitis
Multiphase CT demonstrates innumerable calcified confluent hypodense hypovascular granulomas scattered through the liver parenchyma with left lobe predominance. Note the extrahepatic capsular abscesses and also obliteration of the left and middle hepatic veins. CT was initially felt to be suspicious for invasive primary or metastatic malignancy. Biopsy of the hypodense lesions and extrahepatic masses one day after this CT revealed hepatic parenchyma with marked inflammatory infiltrates, caseating granulomas, and mild bile duct proliferation, consistent with granulomatous hepatitis. Fungal, acid-fast bacteria, and stains were negative for organisms. Patient was negative for hepatitis A, B and C.