Granulomatous Hepatitis with Miliary Mottling: A Rare Cause
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Miliary mottling is most commonly seen in tuberculosis. Clinical features of tuberculosis mimic many other lung diseases.

Published in the Journal of the Association of Physicians of India, the authors report a 40 yr old male with clinical features suggestive of tuberculosis, miliary mottling on skiagram chest and granulomatous hepatitis on histopathology. Case was finally diagnosed as sarcoidosis on liver biopsy and improved on oral corticosteroid.

A 40 year old male presented with complaints of fever and cough since 3 months. He also reported nausea, vomiting, generalized weakness and loss of appetite since last 20 days. There was no h/o hemoptysis, chest pain, dyspnea and joint pain. He was a known case of psoriasis (diagnosed 8 years back) and diabetes mellitus (diagnosed 18 month back).

Patient was on antitubercular treatment since 1 month on the basis of clinical findings and miliary mottlings on skiagram chest but he had no relief. On examination macular, hypopigmented lesions were seen on forearm and legs. There was no pallor, icterus, clubbing and palpable lymphadenopathy. Bilateral few scattered crepts heard on auscultation.

Complete blood count, Renal Function tests were Normal. His Liver Function tests (LFTs) STB/ SGOT/SGPT/Alkaline Phosphatase were 2.6/133/200/500 respectively. MP and Widal were negative. HIV was Non Reactive. Sputum smear was negative for AFB. Mantoux test was negative and urine microscopic examination was Normal. Chest X-Ray PA view showed miliary shadows in bilateral mid and lower zones. USG abdomen showed Hepatosplenomegaly.

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