Up to 70% of patients suffering from HS are asymptomatic [6], while a majority of those who develop symptoms claim abdominal pain. In this context, an abdominal examination may reveal hepatomegaly and possibly splenomegaly [1]. Constitutive symptoms like fatigue, fever, and arthralgia have occasionally been reported. Few patients present with cholestasis and consequent pruritus, jaundice, pale stools and dark urine. Others suffer from portal hypertension. The latter commonly results from biliary cirrhosis and may lead to ascites, peripheral edema, and right heart failure [3]. Similarly, portal hypertension open link may be caused by the formation of thrombi in hepatic veins, a condition known as Budd-Chiari syndrome .

Of note, sarcoidosis is a systemic disease rarely limited to the liver. Thus, patients may present with lymphadenopathy, pulmonary sarcoidosis, skin lesions, uveitis and neurological deficits, among others. In fact, the presence of symptoms not consistent with hepatic disease is of major importance to diagnose HS.

• Abdominal Lymphadenopathy

  In addition there was fever, itching, splenomegaly and abdominal lymphadenopathy in some. CT scan revealed mediastinal lymphadenopathy in all. Liver biopsy showed noncaseating epithelioid granulomas. [ncbi.nlm.nih.gov]

  Extensive abdominal lymphadenopathy in sarcoidosis. Am J Gastroenterol 1981; 75 :367–9. 26. Noel, JM, Katona, IM, Pineiro-Carrero, VM. Sarcoidosis resulting in duodenal obstruction in an adolescent. J Ped Gastroenterol Nutr 1997; 24 :594–598. 27. [nature.com]

• Weight Loss

  Clinical presentation was with weight loss, hepatomegaly and abnormal liver function tests. In addition there was fever, itching, splenomegaly and abdominal lymphadenopathy in some. CT scan revealed mediastinal lymphadenopathy in all. [ncbi.nlm.nih.gov]

  Abdominal pain and pruritus are noted ~15% while fever, weight loss and jaundice less than 5%. There is elevation in serum transferases in 50-70% however, the degree is less than the alkaline phosphatase. [imrespdx.com]

  He started noticing weight loss in 1994; over a period of a few months his weight decreased from 55-60 kg to 40 kg. [jpma.org.pk]

  More generalized symptoms of sarcoidosis include: weight loss, fatigue, night sweats, fever, or just an overall feeling of ill health. It is important to note that sarcoidosis is usually not crippling. [emedicinehealth.com]

  Hepatic sarcoidosis may present as fatigue, RUQ abdominal pain, pruritus, jaundice, weight loss, and fever. 3 Features of esophageal sarcoidosis include dysphagia from impaired motility, esophagitis, stricture, or extrinsic compression from paraesophageal [acgcasereports.gi.org]

• Ascites

  Ascites can be secondary to cirrhosis/ portal hypertension or cardiac/pulmonary hypertension. Peritoneal involvement can also lead to ascites even if liver is not involved. [omicsonline.org]

  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. [ncbi.nlm.nih.gov]

  The latter commonly results from biliary cirrhosis and may lead to ascites, peripheral edema, and right heart failure. [symptoma.com]

  Ascites is usually a transudate from right heart failure (because of pulmonary hypertension) or portal hypertension (because of biliary cirrhosis). Rarely, an exudative ascites may occur from studding of the peritoneum with nodules. [nature.com]

  Sandhu BS, Sanyal SJ: Management of ascites in cirrhosis. Clin Liver Dis 2005, 9 :715–732. PubMed CrossRef Google Scholar 19. Adler RA, Funkhouser HL, Petkov VI, Berger MM: Glucocorticoid-induced osteoporosis in patients with sarcoidosis. [link.springer.com]

• Anemia

  Anemia may be associated with sarcoidosis. Anemia of chronic disease is not due to iron deficiency and will not be helped by iron supplements. [chronicillnessrecovery.org]

  There are bone symptoms of Sarcoidosis, including anemia resulting from granulomas which affect the bone marrow. Other symptoms may include swelling, commonly in the fingers, as well as painless holes in bones. [disabled-world.com]

  Acute appendicitis and pernicious anemia as complications of gastrointestinal sarcoidosis. Am J Gastroenterol 1984; 79 :868–872. 30. Romero-Gomez, M, Suarez-Garcia, E, Otero, MA, et al. [nature.com]

  […] sarcoidosis. [26] Leukopenia is less common and occurs in even fewer persons but is rarely severe. [26] Thrombocytopenia and hemolytic anemia are fairly rare. [18] In the absence of splenomegaly, leukopenia may reflect bone marrow involvement, but the [en.wikipedia.org]

  […] nodosa） 閉塞性血栓性血管炎（Buerger病）：thromboangitis obliterans 粥状硬化症：athelosclerosis Monckeberg動脈硬化症：Monckeberg's obliterans 動脈瘤：aneurysm 解離性大動脈瘤：dissecting aneurysm 静脈瘤：varicose vein ◎大動脈嚢胞状中膜壊死：cystic medial necrosis of aorta 血栓症：thrombosis リンパ・造血系 1）骨髄 貧血：anemia [medical-e.net]

• Congestive Heart Failure

  Sarcoidosis can also cause the heart to beat abnormally. Inflammation of the heart muscle may occur, making the heart lose its ability to pump blood all through the body. This condition is called congestive heart failure. [aafp.org]

  Sarcoidosis can cause the heart to beat abnormally. It can also cause the heart to be unable to pump blood properly. This is called congestive heart failure. Symptoms involving the bones may include pain, swelling and joint stiffness. [familydoctor.org]

  Against Congestive Heart Failure (ATTACH) trial. [link.springer.com]

• Malaise

  We reported a 69-year-old female patient with abdominal pain, malaise, vertigo, headaches, hands tremor and partial loss of hearing. [ncbi.nlm.nih.gov]

  Fever, malaise, and other systemic symptoms are the usual presenting manifestations of an infective etiology; prolonged FUO is especially common in TB and fungal infections. The history is critical in establishing a drug etiology. [hepatitiscentral.com]

• Gastropathy

  Upper endoscopy disclosed congestive ulcerated gastropathy in one case and atrophic fundic gastropathy in the other case, biopsies showed non caseating granuloma. [panafrican-med-journal.com]

• Hypertension

  Corticosteroids did not prevent the development of portal hypertension. [ncbi.nlm.nih.gov]

• Hepatomegaly

  Clinical presentation was with weight loss, hepatomegaly and abnormal liver function tests. In addition there was fever, itching, splenomegaly and abdominal lymphadenopathy in some. CT scan revealed mediastinal lymphadenopathy in all. [ncbi.nlm.nih.gov]

  […] lab test results and imaging studies and did not trigger any symptoms. 88% of patients with liver involvement had elevated alkaline phosphatase levels. 90% of those with liver involvement had high levels of gamma-glutamyl transferase. 3 patients had hepatomegaly [mdedge.com]

• Jaundice

  Abstract Two cases of sarcoidosis with predominantly hepatic involvement are reported, both with the gradual development of progressive jaundice and other clinical features of primary biliary cirrhosis without immunologic or morphologic evidence of that [ncbi.nlm.nih.gov]

  There are small trials suggesting the use of urosodeoxycholic acid in those with cholestatic jaundice with pruritus. [imrespdx.com]

  Right upper quadrant pain, fatigue, jaundice and pruritis are the common presenting symptoms. Long standing complications include cirrhosis and sequelae of portal hypertension. [omicsonline.org]

• Scleral Icterus

  Physical exam revealed scleral icterus, generalized lymphadenopathy, and tender hepatosplenomegaly. To evaluate his symptoms, an esophagogastroduodenoscopy (EGD) was done and showed esophageal varices and a gastric ulcer. [acgcasereports.gi.org]

• Arthralgia

  Constitutive symptoms like fatigue, fever, and arthralgia have occasionally been reported. Few patients present with cholestasis and consequent pruritus, jaundice, pale stools and dark urine. Others suffer from portal hypertension. [symptoma.com]

  Abstract A 35-year-old man presented with a 3-year history of arthralgia and purple coloration of the skin of his fingers and feet. Hand and foot radiography showed cystic bone lesions on phalanges suggestive of sarcoidosis. [reumatologiaclinica.org]

• Night Sweats

  How to Stop Night Sweats in Men and Women Night sweats generally are a symptom of an underlying problem that may require medical treatment. [emedicinehealth.com]

  He denied persistent fever, night sweats, cough, shortness of breath, change in appetite, diarrhea, lack of energy, joint pains or skin changes. [jpma.org.pk]

  She endorsed a 13-pound weight loss over the prior few months but denied additional symptoms, including fevers, chills, night sweats, and other gastrointestinal symptoms. Physical examination found scleral icterus but was otherwise unremarkable. [acgcasereports.gi.org]

  General symptoms of Sarcoidosis include fever, sleep problems, night sweats, fatigue, weakness, and a sense of feeling ill. [disabled-world.com]

Elevated serum concentrations of alkaline phosphatase and γ-glutamyltransferase are characteristic of but not specific for HS. Indeed, the incidental detection of such anomalies is often the first hint at the disease. They may or may not be accompanied by increases in alanine aminotransferase and aspartate aminotransferase concentrations. Furthermore, enhanced levels of serum angiotensin-converting enzyme have repeatedly been measured in samples obtained from HS patients.

Foci of granulomatous inflammation may be visualized applying sonography, computed tomography, or magnetic resonance imaging [7] [8]. Granulomas typically depict as hypointense or hypodense areas and often concentrate in periportal regions. Granulomas are usually observed in lymph nodes and other end-organs, too [9]. Because isolated HS is very rare [10], the presence of granulomas in non-hepatic tissues is sometimes considered a prerequisite for the diagnosis of HS.

Based on blood tests and diagnostic imaging alone, it may be difficult to distinguish HS from tuberculosis. In order to do so, biopsy specimens have to be obtained and examined for the presence of acid-fast bacilli. Additionally, histopathological analyses of such samples allow to rule out malignancies. HS-related granulomas are non-caseating, epithelioid granulomas.

• Granulomatous Tissue

  The infiltrative mass was likely an outgrowth of the granulomatous tissue infiltration or pseudotumor, giving the appearance of an obstructing tumor. The mass resolved with steroid therapy. A unifying diagnosis was initially difficult. [acgcasereports.gi.org]

• Liver Biopsy

  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. [ncbi.nlm.nih.gov]

  Liver biopsy was the key to the diagnosis. According to UpToDate, 50-65% of patients with sarcoidosis have granulomas on liver biopsy. Symptomatic sarcoid only occurs in 5-15% of instances. [imrespdx.com]

The current body of research in regard to treatment suggests steroids to be the mainstay of therapy. However, there is a role for additional immunosuppressive therapy in cases where the initial treatment is refractory to steroids. [ncbi.nlm.nih.gov]

Treatment was specified as well as the outcome. Response to treatment was evaluated after 12 months of therapy. [panafrican-med-journal.com]

Portal hypertension due to sarcoid liver disease can have a favourable prognosis and early referral for port-systemic shunting may be inadvisable. [ncbi.nlm.nih.gov]

While HS is generally associated with a favorable prognosis, liver transplantation may become necessary in severe cases. [symptoma.com]

Course and prognosis of sarcoidosis around the world. Am. J. Mcd, 1974:57:847-52. 18.Edmondstone WM, Wilson AG, Sarcoidosis in Caucasians, Blacks, and Asians in London, Br. J. Dis. Chest, 1985:79:27-36. 19.Mana 3, Salazar A. Manresa F. [jpma.org.pk]

Seite 117 - Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology 191 (3): 675-680 141. ‎ [books.google.de]

In some studies, the starting dose of 30 mg/day was proven sufficient to improve prognosis. [casesjournal.biomedcentral.com]

Focus should be on discovering the etiology of the disease to target therapy at prevention, not cure. [ncbi.nlm.nih.gov]

Hepatic Granulomas Etiology The causes of liver granulomas are legion. [hepatitiscentral.com]

and the Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit (B.A.R.). Address reprint requests to Dr. [nejm.org]

Hospital, age, racial, occupational, geographical, clinical and survivorship characteristics in the epidemiology of sarcoidosis. Am. J. Epidemiol., 1971:94:222-30. 17.Siltzbach LE, James DG. Neville F. et al. [jpma.org.pk]

Epidemiology of sarcoidosis: recent advances and future prospects. Semin Respir Crit Care Med 2007;28:22–35. 4. Kang EH. Sarcoidosis in Korea: revisited. J Korean Med Assoc 2008;51:925–932. 5. [synapse.koreamed.org]

"The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival" (PDF). American Journal of Epidemiology. 123 (5): 840–5. [en.wikipedia.org]

Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics. CT findings in severe thoracic sarcoidosis. [chronicillnessrecovery.org]

Pathophysiology Granuloma formation is incompletely understood. The lesions are regarded as a host attempt to protect against poorly soluble exogenous or endogenous irritants. [hepatitiscentral.com]

Pathophysiology A granuloma is a localized collection of chronic inflammatory cells with epithelioid cells and giant multinucleated cells. Caseation necrosis or foreign body tissue (eg, schistosome eggs) may be present. [merckmanuals.com]

The exact mechanism of this relation is not known, but some evidence supports the hypothesis that this is a consequence of Th1 lymphokine prevalence. [55] [82] Tests of delayed cutaneous hypersensitivity have been used to measure progression. [83] Pathophysiology [en.wikipedia.org]

Focus should be on discovering the etiology of the disease to target therapy at prevention, not cure. [ncbi.nlm.nih.gov]

Prevention Can sarcoidosis be prevented or avoided? There is no way to avoid getting sarcoidosis. If you are at higher risk for the disease, it may be better for you to avoid environmental substances that are known to trigger it. [familydoctor.org]

Sarcoidosis is an inflammatory disease of unknown etiology that may comprise distinct organ systems. While pulmonary sarcoidosis is most frequently observed, up to 70% of sarcoidosis patients present with non-caseating granulomas in hepatic tissues [1]. This condition is referred to as hepatic sarcoidosis (HS). Affected individuals are mostly asymptomatic, but may develop cholestasis and portal hypertension. To date, there is no cure for HS and patients are most commonly prescribed anti-inflammatory drugs to limit disease progression [2] [3]. While HS is generally associated with a favorable prognosis, liver transplantation may become necessary in severe cases [4]. Otherwise, sarcoidosis-related morbidity and mortality mainly result from pulmonary, cardiac and central nervous system involvement [5].

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