Background:Granulomas in pediatric liver biopsies (GPLB) are rare with the largest pediatric cohort reported over 25 years ago.Methods:Single-center retrospective study of GPLB.Results:Seventeen liver biopsies from 16 patients with granulomas were identified (9 boys, 56%) with a median age of 13 years (range: 1–18) for which the most common indication was the presence of a nodule/mass (47%). Significant comorbidities were seen in 13 patients (81%) and included: liver transplant (25%), history of a neoplasm (25%), autoimmune hepatitis (6%), Crohn disease (6%), bipolar disorder (6%), severe combined immunodeficiency (6%), and sickle cell disease (6%). Eleven patients were taking multiple medications at the time of biopsy. Granulomas were more commonly pan-acinar (11 cases) followed by subcapsular (4 cases), portal (1 case), and periportal (1 case). Necrosis was seen in 10 cases (59%). GMS stain was positive in 2 cases for Histoplasma-like yeast; microbiological cultures were negative in all cases (no: 4). A 18S and 16S rRNA gene sequencing performed in 15 cases revealed only 1 with a pathogenic microorganism, Mycobacterium angelicum.Conclusion:In our experience, GPLB are heterogenous with only 3 cases having an identifiable infectious etiology and many of the remaining cases being associated to multiple medications, suggesting drug-induced liver injury as possible etiology.

中文翻译：

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儿科肝脏活检中的肉芽肿：单中心经验

背景：儿科肝活检 (GPLB) 中的肉芽肿很少见，最大的儿科队列报告已超过 25 年前。方法：GPLB 的单中心回顾性研究。结果：鉴定出 16 名肉芽肿患者的 17 份肝活检（9 名男孩，56 名男孩） %），中位年龄为 13 岁（范围：1-18），最常见的指征是存在结节/肿块 (47%)。13 名患者 (81%) 出现明显的合并症，包括：肝移植 (25%)、肿瘤病史 (25%)、自身免疫性肝炎 (6%)、克罗恩病 (6%)、双相情感障碍 (6%) 、严重联合免疫缺陷（6%）和镰状细胞病（6%）。11 名患者在活检时正在服用多种药物。肉芽肿更常见的是全腺泡（11 例），其次是包膜下（4 例）、门管（1 例）和门管周围（1 例）。坏死10例（59%）。2例组织胞浆菌GMS染色阳性；所有病例的微生物培养均为阴性（病例数：4）。对 15 例病例进行的 18S 和 16S rRNA 基因测序显示，只有 1 例带有病原微生物当归分枝杆菌。结论：根据我们的经验，GPLB 具有异质性，只有 3 例具有可识别的传染性病因，其余许多病例与多种病原体相关。药物治疗，表明药物引起的肝损伤可能是病因。