TNF and hepatic granuloma: Sarcoidosis-like reactions have been reported after treatment with TNF alpha blockade drugs [31, 32, 35], However, so far, no evidence in the literature to indicate that abatacept causes granulomatous hepatitis in humans, but probably because majority of patients with drug induced hepatic granuloma are asymptomatic and 60% of them are reported to have elevated transaminases but did not meet the criteria for liver biopsy.