Systemic Granulomatous Reaction to a Foreign Body after Hip Replacement

To the Editor: A 61-year-old man was hospitalized because of an unexplained weight loss of 8 kg and fatigue. Eight years earlier, he had undergone a total hip arthroplasty on the left side (with a prosthetic femoral component of titanium and an acetabular shell of polyethylene) because of arthrosis. The physical examination showed hepatomegaly and splenomegaly. A liver-biopsyspecimen showed granulomatous hepatitis associated with rare intracytoplasmic dark particles initially misinterpreted as a formalin-pigment artifact. The results of clinical and laboratory studies ruled out infectious hepatitis, sarcoidosis, prior hepatic or biliary disease, vasculitis, inflammatory colitis, drug-induced hepatitis, and toxic effects of . . .