Challenges in Diagnosing Hepatic Sarcoidosis: A Case Report

Hepatic sarcoidosis is rare, and its similarity to liver metastases complicates the diagnosis. This mimicry requires a thorough diagnostic investigations to exclude neoplasia and other granulomatous diseases, particularly tuberculosis. A 36-year-old male presented with a two-month history of right hypochondrial tenderness, anorexia, asthenia, and weight loss. Clinical examination showed hepatomegaly and splenomegaly. A CT scan revealed non-compressive mediastinal lymphadenopathy and nodular hepatosplenomegaly. Liver function tests indicated cholestasis. The differential diagnosis included lymphoma, metastases, tuberculosis, and sarcoidosis. Biological assessments were normal except for elevated serum angiotensin-converting enzyme (120 U/L) and hypoalbuminemia with polyclonal hypergammaglobulinemia. A CT-guided liver biopsy showed non-caseating granulomas. Tuberculosis tests, including acid-fast bacilli, GeneXpert (Cephei Corp., Sunnyvale, CA) cultures, and Quantiferon (QIAGEN, Venlo, Netherlands) were negative. Multidisciplinary discussion supported sarcoidosis based on clinical, biological, radiological, and histological findings. Hepatic sarcoidosis can mimic conditions like tuberculosis and metastases. Accurate diagnosis is crucial for appropriate management, highlighting the need for awareness of atypical presentations.