title: Granulomatous hepatitis following open heart surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  Cardiopulmonary bypass (CPB) initiates an inflammatory cascade, predisposing the patient to a number of infections. The stress of surgery and anaesthesia further expose the patient to a variety of non-infectious complications. We report a group of patients who developed granulomatous disease after open heart surgery.
  
  
  METHODS
  We retrospectively analysed a subset of patients who developed a syndrome of fever, jaundice and hepatomegaly after open heart surgery. We recruited age- and sex-matched controls who underwent open heart surgery during the same period (July 2002-July 2004). Details of demographic profiles, diagnostic evaluation and drug treatment were noted and compared between the two groups using the SPSS software.
  
  
  RESULTS
  Five patients were identified to have the specific syndrome of high grade intermittent fever with jaundice and hepatomegaly with investigations revealing an intrahepatic cholestasis. A detailed evaluation revealed granulomas in tissue specimens of the bone marrow and/or liver in these patients. An extensive evaluation for an alternative aetiological agent was non-contributory.
  
  
  CONCLUSIONS
  We found granulomatous hepatitis in 5 patients following open heart surgery and they were given conventional antituberculous therapy to which they responded. It is possible that in these patients, tuberculosis was re-activated from a dormant focus due to a period of transient immunodeficiency caused by an extracorporeal circulation.
authors.affiliation: Christian Medical College, Vellore 632004, Tamil Nadu, India. prisci@cmcvellore.ac.in
authors.forename: P
authors.initials: P
authors.lastname: Rupali
authors.forename: S B
authors.initials: SB
authors.lastname: Evangelynn
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
authors.forename: R J
authors.initials: RJ
authors.lastname: Korula
authors.forename: V
authors.initials: V
authors.lastname: Shukla
authors.forename: R
authors.initials: R
authors.lastname: Thankachen
authors.forename: M
authors.initials: M
authors.lastname: Ponniah
authors.forename: S
authors.initials: S
authors.lastname: Subramanian
authors.forename: V
authors.initials: V
authors.lastname: Jeyaseelan
authors.forename: D
authors.initials: D
authors.lastname: Mathai