Granulomatous phlebitis of small hepatic veins is possibly associated with Propionibacterium acnes infection.

Although epithelioid granulomas typically involve liver parenchyma and/or walls of the tributaries of the portal or hepatic veins, idiopathic granulomatous lesions selectively involving the small hepatic veins have infrequently been reported.1 On rare occasions, sarcoidosis causes Budd-Chiari syndrome through granulomas involving centrilobular parenchyma and large hepatic vein radicle.2 Precise pathogenic mechanisms inducing sarcoidosis are unknown; however, hypotheses strongly suggest it may occur in genetically susceptible individuals due to environmental exposures. Hepatic granulomas are identified in several hepatic diseases such as sarcoidosis, primary biliary cholangitis, and tuberculosis. [Extracted from the article]