{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:05:58Z","timestamp":1784786758659,"version":"3.55.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ANCA-associated vasculitides (AAV) \u2014 granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and microscopic polyangiitis (MPA) \u2014 are rare small-vessel autoimmune diseases. Liver involvement in AAV is uncommon and generally manifests as biochemical hepatitis; true hepatic granulomatosis is exceedingly rare and diagnostically challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic scoping review following PRISMA-ScR guidelines and the Arksey &amp;amp; O\u2019Malley framework, searching PubMed, Google Scholar, ScienceDirect, and Scopus without date restriction (through March 2026). A total of 7, 033 records were initially retrieved; after deduplication, title\/abstract screening, and full-text review, five articles meeting strict inclusion criteria were included for qualitative synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five published cases of hepatic granulomas in AAV patients with no confirmed confounding etiology were identified. All were GPA or EGPA; no case of pure MPA was documented. Three patients were female and two were male, with a mean age of 57.6 years. Liver histology revealed non-necrotizing epithelioid granulomas (n = 2), granulomatous inflammation with necrosis (n = 1), incomplete septal cirrhosis with vasculopathic changes (n = 1), and incidental calcified granulomas (n = 1). Immunosuppressive therapy with corticosteroids and\/or cyclophosphamide achieved clinical and biochemical improvement in all treated patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hepatic granulomatosis is a rare but genuine extra-respiratory manifestation of AAV, most frequently reported in GPA. It may antedate the canonical ENT-pulmonary-renal triad, presenting as incidental hepatomegaly or unexplained liver function test elevation. Systematic exclusion of competing etiologies (sarcoidosis, tuberculosis, primary biliary cholangitis, drug-induced hepatitis) is mandatory before attributing granulomas to AAV. Liver biopsy remains pivotal in confirming the diagnosis. Immunosuppression is the therapeutic cornerstone, with generally favourable outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1879137","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:38:38Z","timestamp":1784785118000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hepatic granulomas as a manifestation of ANCA-associated vasculitis:a systematic review"],"prefix":"10.3389","volume":"17","author":[{"given":"Tayssir","family":"Ben Achour","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrine","family":"Ben Hadj Dahman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maysam","family":"Jridi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imed","family":"Ben Ghorbel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Naceur","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monia","family":"Smiti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar","place":["Tunis, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22126474","article-title":"Granulomatous inflammation in ANCA-associated vasculitis","volume":"22","author":"M\u00fcller","year":"2021","journal-title":"Int J Mol 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