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Ten days later he had tender hepatomegaly. The white blood cell count was 12. Antimitochondrial antibodies were negative but anti-nuclear antibodies and antibodies against smooth muscle were positive. Extensive tests to exclude other causes of granulomatous hepatitis were all negative. A liver biopsy showed multiple granulomata consisting of epithelioid cells, multinucleated giant cells, plasma cells, and lymphocytes. There was slight fibrosis around the granulomata. There was no evidence of cholestasis.

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