Diagnosis and treatment of hepatic sarcoidosis.
ABSTRACT The presence of granulomas in the liver raises consideration of a wide differential diagnosis, but in most Western series, sarcoidosis accounts for a majority of cases. This review will focus specifically on the diagnosis of and therapy for hepatic sarcoidosis. Sarcoidosis is a systemic granulomatous disease of unknown etiology. Hepatic involvement of sarcoidosis was described in 11.5% of 736 patients enrolled in the ACCESS study. However, presence alone of granulomas in an organ in sarcoidosis does not dictate treatment. The decision to treat should be based on symptoms and severity of disease. Although hepatic involvement usually is asymptomatic, a minority of patients progress to chronic cholestatic disease, portal hypertension, and cirrhosis that may require liver transplantation. Treatment of hepatic sarcoidosis should be reserved for patients who manifest this spectrum of disease. Glucocorticoid treatment is first-line therapy for hepatic sarcoidosis, improving symptoms and abnormal laboratory values but generally having no effect on progression of disease. In addition to glucocorticoids, immunomodulators such as azathioprine, methotrexate, hydroxychloroquine, and infliximab have been used with some positive effects on symptoms, liver enzyme abnormalities, and hepatomegaly, but none has been shown to prevent progression of disease. Ultimately, in cases of overt liver failure, liver transplantation is the definitive treatment. Overall, treatment for hepatic sarcoidosis is targeted toward alleviation of symptoms but has no curative potential at this time. Focus should be on discovering the etiology of the disease to target therapy at prevention, not cure.
SourceAvailable from: Savvoula SavvidouGastroentérologie Clinique et Biologique 02/2014; DOI:10.1016/j.clinre.2014.01.003 · 0.80 Impact Factor
Article: Isolated hepatic sarcoidosis[Show abstract] [Hide abstract]
ABSTRACT: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Although hepatic granulomas occur in 50-65% of patients with systemic sarcoidosis, isolated liver sarcoidosis is rare. Clinical presentation varies from asymptomatic to manifest. The diagnosis is based on a characteristic histopathological finding of liver biopsy. We reported a 69-year old man was admitted due to abdominal swelling and abdominal pain. Laboratory studies detected: cholestasis, pancytopenia and elevaton of angiotensin-converting enzyme. Abdominal imaging techniques showed liver cirrhosis, splenomegaly and ascites. The diagnosis of the hepatic sarcoidosis was confirmed by histopathological examination of liver biopsy. The patient was treated with corticosteroids. After 18 months the patient was without any subjective symptoms, and with biochemical and clinical improvement. Isolated hepatic sarcoidosis should be considered in the differential diagnosis of asymptomatic or simptomatic patients with hepatosplenomegaly and changes in liver functional tests. Only the timely diagnosis and proper treatment can lead to subjective and objective improvement of patients.Vojnosanitetski pregled. Military-medical and pharmaceutical review 04/2014; 71(4):399-403. DOI:10.2298/VSP1404399J · 0.27 Impact Factor
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ABSTRACT: A 59-year-old woman, who was given a diagnosis of sarcoidosis by supraclavicular lymph node biopsy 5 years previously, was admitted for further examination following abnormal radiologic findings. Nodular pulmonary and abdominal lesions were observed by computed tomography, and liver biopsy was performed and showed epithelioid cell granulomas. She was asymptomatic and was followed up with no therapy. At 1 year follow-up, the pulmonary and abdominal lesions had nearly complete resolution. Nodular pulmonary and abdominal lesions in patients with sarcoidosis can mimic metastatic disease, lymphoma, and infection, and can reappear during disease activity. Therefore, differential diagnosis and continual follow-up are important.01/2014; 52(1):71-4. DOI:10.1016/j.resinv.2013.05.003