Abstract: Objective To summarize the clinical characteristics of Granulomatous Hepatitis (GH) to improve the awareness, diagnosis and management of the disease. Methods We retrospectively collected clinical data of 36 GH patients treated from January 2016 to March 2024 at Beijing Friendship Hospital, Capital Medical University. Subgroup analyses were conducted based on etiologies, spontaneous remission, prognosis, and relapse. Methods The median age of 36 GH patients was 51.0 years old, with a higher prevalence in females (Female∶Male, 1.25∶1). All patients had liver enzyme abnormalities; there are 14 cases of hepatocellular injury type (38.8%), 17 cases of cholestasis type (47.2%), and 5 cases of mixed type (13.8%). The median ALT is 137.50 (range 30.7-235.3) U/L, and the median ALP is 132.6(range 98.6-198.5) U/L. In subgroup analyses, drug-related(47.2%)and idiopathic(19.4%) etiologies were the most common causes of GH. Patients with drug-related GH had significantly higher ALT and AST levels compared to those with idiopathic GH and sarcoidosis (P<0.05). Granulomas were found in the portal areas (41.7%) or within the lobules (38.9%), with a minority (19.4%) of patients having granulomas present in both the portal areas and within the lobules. The predominant type of granuloma was non-necrotizing epithelioid granuloma (83.3%). All patients exhibited inflammation within the lobules, with the majority (83.3%) having varying degrees of inflammation in the portal areas. Most patients (61.1%) showed no signs of fibrosis, and the vast majority of patients (91.7%) had bile duct injury, with only one case showing bile duct loss. Patients treated with corticosteroids showed significantly higher ALP level compared to those with spontaneous remission (P=0.003). The ALP level demonstrated good predictive performance for spontaneous remission (AUC 0.796(95%CI 0.649-0.943). Conclusion GH is a rare chronic inflammatory liver disease, characterized by non-specific clinical manifestations and a variety of causes. Liver biopsy can help the diagnosis. Corticosteroid therapy is commonly used in patients with GH and results in a favorable prognosis for most patients.

Key words: Granulomatous Hepatitis, Corticosteroids, Treatment, Spontaneous Remission