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Hepatic Involvement in Systemic Sarcoidosis.

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  • 1Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA.

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Hepatic sarcoidosis, often asymptomatic, can cause severe liver damage like cirrhosis. Early detection and steroid treatment are crucial for managing this systemic disease and preventing liver failure.

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Area of Science:

  • Internal Medicine
  • Gastroenterology
  • Pulmonology

Background:

  • Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas.
  • Hepatic sarcoidosis, though common, is frequently asymptomatic and underdiagnosed compared to pulmonary or lymphatic involvement.

Observation:

  • A 68-year-old female with known pulmonary sarcoidosis presented with severe abdominal pain and epigastric tenderness.
  • Abdominal MRI revealed mild hepatic fibrosis and cirrhosis; liver biopsy confirmed non-necrotizing granulomas consistent with sarcoidosis.

Findings:

  • Hepatic sarcoidosis can manifest asymptomatically in most cases (70-95%).
  • Symptomatic presentations may include abdominal pain, jaundice, nausea, vomiting, and hepatosplenomegaly.
  • Rare complications include cholestasis, portal hypertension, cirrhosis, and Budd-Chiari syndrome.

Implications:

  • Prompt diagnosis and treatment of hepatic sarcoidosis, primarily with corticosteroids, are vital.
  • Untreated hepatic sarcoidosis can progress to severe liver damage, including cirrhosis and liver failure.
  • Longitudinal monitoring of patients with sarcoidosis is essential for early identification and management of hepatic involvement.