Journal of Yeungnam Medical Science

Case report

Primary hepatic sarcoidosis presenting with cholestatic liver disease and mimicking primary biliary cholangitis: a case report: Young Joo Park, Hyun Young Woo, Moon Bum Kim, Jihyun Ahn, Jeong Heo; J Yeungnam Med Sci. 2022;39(3):256-261. Published online August 10, 2021; DOI: https://doi.org/10.12701/yujm.2021.01151

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Sarcoidosis often involves the liver. However, primary hepatic sarcoidosis confined to the liver without evidence of systemic involvement is rare. We report the case of a 37-year-old man with hepatic sarcoidosis who initially presented with elevated liver enzymes and suspicious cirrhotic nodules on computed tomography. The patient had cirrhosis but did not have portal hypertension. Based on the initial histopathologic finding of chronic granulomatous inflammation and the common clinical characteristics of sarcoidosis, he was initially diagnosed with primary biliary cholangitis, and his daily dosage of ursodeoxycholic acid was increased to 900 mg. After 14 months of treatment, his total serum bilirubin concentration was 10.9 mg/dL (upper normal limit, 1.2 mg/dL). Additionally, a transjugular liver biopsy revealed multiple noncaseating granulomas. He was diagnosed with primary hepatic sarcoidosis involving the lungs, heart, spleen, kidneys, and skin. Treatment with methylprednisolone was initiated. Two weeks later, he was started on azathioprine, and the dose of steroid was simultaneously reduced. These findings indicate the importance of including hepatic sarcoidosis as a possible diagnosis in patients with elevated liver enzymes or cryptogenic cirrhosis.

Citations

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Liver biopsy as a useful diagnostic tool for hepatic sarcoidosis: A case report
Kenrei Uehara, Tatsuo Kanda, Shuhei Arima, Mai Totsuka, Masayuki Honda, Ryota Masuzaki, Reina Sasaki‑tanaka, Naoki Matsumoto, Masahiro Ogawa, Hirofumi Kogure
Medicine International.2024;[Epub] CrossRef
Navigating Challenges in a Case of Unusual Hepatic and Pulmonar Sarcoidosis: A Comprehensive Clinical Journey
André Gonçalves, Diogo Simas, Plácido Gomes, Carina Leal, Catarina Atalaia-Martins, Helena Vasconcelos
GE - Portuguese Journal of Gastroenterology.2024; : 1. CrossRef
The clinical management of hepatic sarcoidosis: A systematic review
Ram Prasad Sinnanaidu, Vikneshwaran Chandra Kumar, Ranita Hisham Shunmugam, Sanjiv Mahadeva
JGH Open.2024;[Epub] CrossRef

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