# More on hepatic granulomas

## TL;DR

This paper discusses a case of hepatic granuloma possibly caused by surgical staples, but highlights the need to rule out other common causes like hepatitis B/C and PBC.

## Contribution

The paper emphasizes the importance of excluding infectious and autoimmune causes before attributing hepatic granulomas to surgical materials.

## Key findings

- Hepatic granulomas are reported in 5% of liver biopsies and can be caused by various diseases.
- Chronic hepatitis B and C are the most common causes of liver damage in patients with renal failure.
- The prevalence of hepatic granulomas in patients with chronic hepatitis B and C is 1.5% and 1.3%, respectively.

## Abstract

We have read the case report of Nihon-Yanagi et al. The patient they described developed hepatic granuloma two times and the granulomatous lesion was surrounding metal staples/clips suggesting that the granuloma was due to surgical staples/clips.

Hepatic granulomas (HGs) are reported in around 5 % of patient who undergo a liver biopsy and caused by several diseases including sarcoidosis, tuberculosis, hydatid cyst, brucellosis, typhoid fever, chronic hepatitis B and C and primary biliary cirrhosis (PBC). Chronic hepatitis B and C infections are the most common and serious causes of liver damage in patient with renal failure. Their prevalence is a higher than people without renal failure. We have previously reported that the prevalences of HGs in patients with chronic hepatitis B and C are 1.5 and 1.3 % respectively. The described patient was on hemodialysis for 12 years. The other causes of HG seem excluded; however hepatitis B and C infections and PBC should have been tested and excluded before ascribing the HGs to surgical staples/clipping material.