Two diagnoses, similar clinical presentation: unexpected hepatic sarcoidosis during laparoscopic cholecystectomy

A man in his late 20s presented to the emergency department with 4 months of progressive colicky pain, suspected of cholecystolithiasis. Abdominal ultrasonography confirmed the presence of gallstones. Laboratory tests showed no abnormalities. Due to the severity of his symptoms, an emergency laparoscopic cholecystectomy was scheduled. Diffuse intra-capsular, solid, oval, white lesions were observed on the liver intraoperatively. Histological analysis showed granulomatous inflammation consistent with sarcoidosis. Chest CT scan showed mediastinal and hilar lymphadenopathy, also suggestive of sarcoidosis. Because of persistent abdominal pain and the absence of cirrhosis, a laparoscopic cholecystectomy was performed, resulting in the resolution of symptoms. In conclusion, the symptoms of sarcoidosis show a great variety depending on the organs involved. So, when gallstone disease is suspected but atypical findings are observed, it is important to consider the possibility of an alternative underlying cause such as hepatic sarcoidosis, requiring different treatment strategies and follow-up.