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• W2810058383 abstract "A 33-year-male presented with complains of fever, weight loss and abdominal discomfort for one year. Abdominal examination showed mild hepatomegaly there was no palpable lymph nodes. His prior evaluation included, bilateral hilar lymphadenopathy on chest X-ray, hepatosplenomegaly and multiple retroperitoneal lymph nodes on an abdominal ultrasound. A contrast CT of abdomen showed multiple hypodense lesions in liver and spleen, multiple lymph nodes were found in peri-pancreatic, para-aortic and precaval regions measuring from two centimeters to four centimeters in size. Before presenting to us, he was treated elsewhere with anti-tuberculous therapy for eight months on the basis of granulomas in FNAC from abdominal lymph nodes with no clinical response. Liver function tests showed alkaline phosphatase (ALP) of 430 IU/L (30–120) and gamma glutamyl transferase (GGT) of 184 IL/L (7–50), bilirubin and aminotransferases were normal. Serum angiotensin converting enzyme levels were 215.2 (20.0–70.0), liver biopsy confirmed presence of multiple non-caseating granulomas (Figure 1). He was therefore diagnosed with sarcoidosis and treated with corticosteroids, he continues to do well on follow up of more than a year with improvement of biochemical abnormalities and clinical improvement. Liver involvement in sarcoidosis has been reported in the range of 5–30% in various studies. In a population based retrospective study from the U.S., the prevalence of liver involvement was found in 6% of patients with sarcoidosis, being a population based follow up study, this prevalence is likely to be representative.1Ungprasert P. Crowson C.S. Simonetto D.A. Matteson E.L. Clinical characteristics and outcome of hepatic sarcoidosis: a population-based study 1976–2013.Am J Gastroenterol. 2017; 112: 1556-1563Crossref PubMed Scopus (28) Google Scholar Liver involvement in sarcoidosis is usually asymptomatic and may manifest as abnormal liver enzymes mostly ALP and GGT, aminotransferases may be normal or only slightly abnormal, imaging findings include hepatomegaly or hypodense lesions in the liver. Rarely, there may be progression of liver disease with portal hypertension and its manifestations.2Judson M.A. Hepatic, splenic, and gastrointestinal involvement with sarcoidosis.Semin Respir Crit Care Med. 2002; 23: 529-541Crossref PubMed Scopus (66) Google Scholar Diagnosis of sarcoidosis needs multisystem involvement with histologic evidence from one organ and exclusion of other causes of hepatic granuloma such as primary biliary cirrhosis.3Modaresi Esfeh J. Culver D. Plesec T. John B. Clinical presentation and protocol for management of hepatic sarcoidosis.Expert Rev Gastroenterol Hepatol. 2015; 9: 349-358Crossref PubMed Scopus (20) Google Scholar Serum ACE levels may be normal in as many as 40% patients with liver involvement.1Ungprasert P. Crowson C.S. Simonetto D.A. Matteson E.L. Clinical characteristics and outcome of hepatic sarcoidosis: a population-based study 1976–2013.Am J Gastroenterol. 2017; 112: 1556-1563Crossref PubMed Scopus (28) Google Scholar To conclude, sarcoidosis is an important cause of infiltrative liver disease and must be kept in the differential diagnosis of such patients." @default.
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• W2810058383 date "2019-03-01" @default.
• W2810058383 modified "2023-09-27" @default.
• W2810058383 title "Sarcoidiosis: An Important Differential Diagnosis in Patients With Infiltrative Liver Disease" @default.
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• W2810058383 doi "https://doi.org/10.1016/j.jceh.2018.06.006" @default.
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