Granulomas can be found in the liver due to a variety of causes. The most common among these are:
- Medication reactions
- Infections with fungal or acid-fast organisms
- Sarcoidosis
Distinction of these is not always possible, although in all cases, the following stains should be performed to rule out infection.
For fungal organisms (one of the following):
- Grocott-Gomori methenamine-silver stain (GMS)
- Digested periodic acid-Schiff (PAS)
ANDFor acid-fast organisms (one of the following):
Unfortunately, these stains have a relatively high false negative rate, so negative stains should be correlated with clinical and culture findings before excluding an infection.