The Prevalence and Etiology of Hepatic Granulomas in Turkey: A Systematic Review

Objective: Hepatic granulomas (HGs) are seen in 2- 4% of liver biopsies and the etiology is heterogeneous including liver involvement in systemic immunologic disorders and infectious diseases, primary hepatic diseases, drug hepatotoxicity, foreign bodies, and reaction to neoplastic disease. Common etiologies are primary biliary cholangitis (PBC) and sarcoidosis in the Western world, while infections especially tuberculosis (TB) preclude in the Eastern countries. In Turkey, HGs have been reported in 2-5% of liver biopsies and the etiology includes both infections and non-infectious diseases. In this review, we aimed to determine the prevalence and etiology of HGs in Turkey. Material and Methods: A search of Pubmed, Scopus and Science Citation Index and national databses (including Tübitak Ulakbim, Türkmedline, and Türk Atıf Dizini) was done and 60 reports were reached. Four studies from Turkey dedicated to describe the rate of HGs and their etiology were determined. Results: The rate of HGs is 2.27% (208/9164). Infections as a group (TB, hydatid disease, HCV, brucellosis, fascioliasis, typhoid fever, fungal infection, HBV, actinomycosis, yersiniosis, leishmaniasis, and infectious mononucleosis) were the etiology in 38.4%. PBC was the leading etiology, followed by sarcoidosis, TB, and hydatid disease. Beside the dedicated HG series, 11 series from Turkey included cases with HGs and 45 papers described 52 case reports with HGs. Conclusion: HGs are seen in 2.3% of the liver biopsies in Turkey. The infections still represent the leading etiology and among them, TB appears the commonest one. When the cases are evaluated individually, PBC is the leading etiology. Infections are followed by PBC and sarcoidosis, which are main two etiologies of HGs in the world. The local and regional epidemiology of certain infectious diseases, particularly TB determines the etiologic distribution of HGs.