A PATIENT WITH HEPATIC GRANULOMA-FORMATION AND ANGIOTENSIN-CONVERTINGENZYME-PRODUCTION BY GRANULOMA CELLS DURING CLINICAL RELAPSE OF HEPATITIS-A

Elevation of the serum angiotensin-converting enzyme (sACE) level and hepatic granulomas were found during a clinical relapse in a 22 year o ld patient with acute viral hepatitis type A (AVH-A). The serum transa minase level and sACE level remained high for more than 6 months. In t he biopsied specimen of the liver, fibrous rings of granulomas compose d of collagen types I, III, and V were observed. Furthermore, the loca lization of ACE was visible in the rough endoplasmic reticulum of epit helioid cells of granulomas in the liver under electron microscopy usi ng the indirect immunoperoxidase method. These results suggest that gr anuloma cells in the liver caused by hepatitis A may be involved in AC E production. In addition, other diseases associated with the presence of granulomas in the liver, such as lymphoma, cytomegalovirus infecti on, visceral leishmaniasis, and lupoid hepatitis, were ruled out. Howe ver, the hepatic granulomas disappeared with the healing of AVH-A. In this regard, the present case is considered to be one of the very few cases of hepatic sarcoidosis.