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Mitchell R, Khan H, Reyes JVM. Hepatic Sarcoidosis Found Incidentally in a Patient Presenting With Recurrent Clostridium difficile Infections. Cureus 2024; 16:e55316. [PMID: 38559541 PMCID: PMC10981841 DOI: 10.7759/cureus.55316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
A 50-year-old female who presented to our hospital for recurrent diarrhea was found to have worsening aminotransferase and alkaline phosphatase levels. Workup revealed lymphadenopathy and hepatomegaly prompting a biopsy of the liver and axillary lymph node, confirming a diagnosis of hepatic sarcoidosis. Our patient later developed cutaneous sarcoidosis. She is currently asymptomatic and is followed by gastroenterology, pulmonary, and dermatology. Recognition of extrapulmonary manifestations of sarcoidosis is important for proper management of patients. Treatment often requires a multidisciplinary approach when more than one organ system is involved.
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Affiliation(s)
- Richard Mitchell
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals-Elmhurst, Queens, USA
| | - Haidar Khan
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals-Elmhurst, Queens, USA
| | - Jonathan Vincent M Reyes
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals-Elmhurst, Queens, USA
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Fauter M, Rossi G, Drissi-Bakhkhat A, Latournerie M, Gerfaud-Valentin M, Durieu I, Jamilloux Y, Bailly F, Mahevas M, Sève P. Hepatic sarcoidosis with symptomatic portal hypertension: A report of 12 cases with review of the literature. Front Med (Lausanne) 2022; 9:995042. [PMID: 36619642 PMCID: PMC9812951 DOI: 10.3389/fmed.2022.995042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Sarcoidosis is a systemic granulomatosis of unknown etiology, characterized by the presence of immune granulomas. Liver damage is a relatively common extra-pulmonary manifestation, occurring in 3.6-30% of cases. Some patients can develop symptomatic portal hypertension (PH). Few series have evaluated the prognosis of symptomatic PH as well as the efficacy and safety of specific treatment on this complication. Methods This is a multicenter retrospective study of cases of histologically proven hepatic sarcoidosis with symptomatic PH (ascites, digestive hemorrhage) and/or hepatic encephalopathy. Demographic characteristics, comorbidities, clinical manifestations of sarcoidosis, biological data, imaging study of the liver, treatment, and clinical outcomes were collected. Results Twelve patients were identified, with a mean follow-up of 140 months. The M/F ratio was 1 and Caucasian origin was the most represented (75%). Seven patients presented with hepatic comorbidities: metabolic syndrome, chronic alcoholism or chronic viral hepatitis. Apart from hepatic involvement, mediastino-pulmonary involvement was the most common followed by osteoarticular and skin. Liver damage was inaugural in two thirds of cases. Nine patients developed ascites, six presented esophageal varices complicated by gastrointestinal bleeding. Three patients presented with both ascites and variceal bleeding. One case of hepatic encephalopathy was observed. Five patients presented signs of hepatocellular insufficiency during follow-up, of whom three had hepatic comorbidities. Eight out of 12 patients required second-line treatment after failure of corticosteroids, three patients underwent ligation of esophageal varices but with recurrent digestive bleeding in all cases. Two patients benefited from a transjugular intrahepatic portosystemic shunt (TIPS), also with poor result. At the end of follow-up, five patients were alive and seven patients died. Two patients received a liver transplant, with good result and without recurrence of sarcoidosis on the transplant thereafter. Two patients had quiet sarcoidosis on low dose of corticosteroids and one patient was lost to follow-up. Conclusion Symptomatic PH related to hepatic sarcoidosis is a severe complication, with high morbidity and mortality, and frequent failure of specific treatments of PH. Early management of these patients, with detection of hepatic comorbidities seems important. In case of therapeutic failure, liver transplantation is an option to consider.
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Affiliation(s)
- Maxime Fauter
- Department of Internal Medicine, Croix-Rousse Hospital, Lyon, France
| | - Geoffrey Rossi
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | | | - Marianne Latournerie
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | | | - Isabelle Durieu
- Department of Internal Medicine, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France,RESHAPE, INSERM U1290, Lyon University, University Claude-Bernard Lyon 1, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Croix-Rousse Hospital, Lyon, France,INSERM U1111, Centre International de Recherche en Infectiologie/International Research Center in Infectiology (CIRI), University Claude-Bernard Lyon 1, Villeurbanne, France
| | - François Bailly
- Department of Hepato-Gastroenterology, Croix-Rousse Hospital, Lyon, France
| | - Matthieu Mahevas
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique – Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Pascal Sève
- Department of Internal Medicine, Croix-Rousse Hospital, Lyon, France,RESHAPE, INSERM U1290, Lyon University, University Claude-Bernard Lyon 1, Lyon, France,Pôle IMER, Hospices Civils de Lyon, Lyon, France,*Correspondence: Pascal Sève,
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Rossi G, Ziol M, Roulot D, Valeyre D, Mahévas M. Hepatic Sarcoidosis: Current Concepts and Treatments. Semin Respir Crit Care Med 2020; 41:652-658. [PMID: 32777850 DOI: 10.1055/s-0040-1713799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatic sarcoidosis is a relatively common manifestation of extrapulmonary sarcoidosis. It occurs in 20 to 30% of cases and is rarely severe. However, a cluster of patients may develop severe complications such as cirrhosis and portal hypertension. In this review, we describe the current knowledge of clinical, biological, pathological, and radiological features of liver involvement in sarcoidosis and discuss essential clues for management and treatment.
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Affiliation(s)
- Geoffrey Rossi
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Marianne Ziol
- Service d'anatomopathologie, Centre Hospitalier Jean-Verdier, Bondy, France
| | - Dominique Roulot
- Service d'Hépatologie, Centre Hospitalier Universitaire Avicenne, Bobigny, France.,Service de Pneumologie, Centre Hospitalier Universitaire Avicenne, Université Sorbonne Paris Nord, APHP, Bobigny, France
| | - Dominique Valeyre
- Service de Pneumologie, Centre Hospitalier Universitaire Avicenne, Université Sorbonne Paris Nord, APHP, Bobigny, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
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Abstract
Budd-Chiari syndrome (BCS), or hepatic venous outflow obstruction, is a rare cause of liver disease that should not be missed. Variable clinical presentation among patients with BCS necessitates a high index of suspicion to avoid missing this life-threatening diagnosis. BCS is characterized as primary or secondary, depending on etiology of venous obstruction. Most patients with primary BCS have several contributing risk factors leading to a prothrombotic state. A multidisciplinary stepwise approach is integral in treating BCS. Lifelong anticoagulation is recommended. Long-term monitoring of patients for development of cirrhosis, complications of portal hypertension, hepatocellular carcinoma, and progression of underlying diseases is important.
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Budd-Chiari Syndrome in a Patient With Simultaneous Diagnosis of Hepatic Sarcoidosis and Nodular Regenerative Hyperplasia. ACG Case Rep J 2019; 6:e00200. [PMID: 31750374 PMCID: PMC6831147 DOI: 10.14309/crj.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare vascular disorder characterized by an obstruction of the hepatic venous outflow. Nodular regenerative hyperplasia (NRH) may develop as a result of an underlying autoimmune disease such as hepatic sarcoidosis. Only a few case reports have described cases with either NRH or hepatic sarcoidosis associated with BCS. We present a 42-year-old man presenting with BCS and signs of portal hypertension who was found to have an underlying pathological diagnosis of both hepatic sarcoidosis and NRH and who was successfully treated with a transjugular intrahepatic portosystemic shunt.
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Ennaifer R, Bacha D, Romdhane H, Cheikh M, Nejma HB, BelHadj N. Budd-Chiari Syndrome: An Unusual Presentation of Multisystemic Sarcoidosis. Clin Pract 2015; 5:768. [PMID: 26900444 PMCID: PMC4736049 DOI: 10.4081/cp.2015.768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/28/2015] [Accepted: 06/23/2015] [Indexed: 12/21/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown origin. All organs may be affected. Liver involvement is common but it is rarely symptomatic. Only a few cases of Budd-Chiari syndrome (BCS) secondary to a hepatic sarcoidosis have been described so far. We describe a case of multisystemic sarcoidosis presenting with BCS. A 42-year old female was referred to our department for chronic and anicteric cholestasis. Laboratory and imaging investigations disclosed features of chronic BCS associated with multisystemic sarcoidosis. The positive diagnosis was based on microscopic features, which showed hepatic, gastric and cutaneous non-caseating granulomas. Screening for an underlying thrombophilic disorder was negative. The diagnosis of BCS complicating hepatic sarcoidosis was the most likely. She was put on corticosteroids and anticoagulation therapy. To our knowledge, few cases of sarcoidosis-related BCS have been reported in the literature. In addition to being an uncommon presentation of sarcoidosis, this case illustrates the importance of recognizing an unusual cause of BCS and its therapeutic difficulties.
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Affiliation(s)
- Rym Ennaifer
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis
- Faculty of Medicine, University of Tunis El Manar, Tunis
| | - Dhouha Bacha
- Faculty of Medicine, University of Tunis El Manar, Tunis
- Department of Pathology, Mongi Slim Hospital, Tunis, Tunisia
| | - Hayfa Romdhane
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis
- Faculty of Medicine, University of Tunis El Manar, Tunis
| | - Myriam Cheikh
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis
- Faculty of Medicine, University of Tunis El Manar, Tunis
| | - Houda Ben Nejma
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis
- Faculty of Medicine, University of Tunis El Manar, Tunis
| | - Najet BelHadj
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis
- Faculty of Medicine, University of Tunis El Manar, Tunis
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Tadros M, Forouhar F, Wu GY. Hepatic Sarcoidosis. J Clin Transl Hepatol 2013; 1:87-93. [PMID: 26357609 PMCID: PMC4521279 DOI: 10.14218/jcth.2013.00016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 12/20/2022] Open
Abstract
Sarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected organs. Pulmonary involvement is the most common site of disease activity. However, hepatic involvement is also common in sarcoidosis, occurring in up to 70% of patients. Most patients with liver involvement are asymptomatic. Therefore, the majority of cases are discovered incidentally, frequently by the finding of elevated liver enzymes. Pain in the right upper quadrant of the abdomen, fatigue, pruritus, and jaundice may be associated with liver involvement. Portal hypertension and cirrhosis are complications linked to long-standing hepatic sarcoidosis. Liver biopsy is usually required to confirm the diagnosis. It is important to differentiate hepatic sarcoidosis from other autoimmune and granulomatous liver diseases. Not all cases of hepatic sarcoidosis require treatment. For symptomatic patients, the first line treatment includes corticosteroids or ursodeoxycholic acid. Various immunosuppressant agents can be used as second line agents. Rarely, severe cases require liver transplantation.
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Affiliation(s)
- Micheal Tadros
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Faripour Forouhar
- Department of Anatomic Pathology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Elloumi H, Marzouk S, Tahri N, Bahloul Z, Azouz M. Sarcoïdose et atteinte hépatique : étude de 25 cas. Rev Med Interne 2012; 33:607-14. [DOI: 10.1016/j.revmed.2012.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/31/2012] [Accepted: 08/07/2012] [Indexed: 02/01/2023]
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10
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Budd-Chiari syndrome as a rare complication of sarcoidosis. Rheumatol Int 2011; 32:3319-20. [PMID: 21898058 DOI: 10.1007/s00296-011-2129-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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Unusual presentation of sarcoidosis in a child. Rheumatol Int 2011; 32:1453-5. [PMID: 21461714 DOI: 10.1007/s00296-011-1909-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
Abstract
Sarcoidosis is a chronic multisystemic granulomatous disease of unknown etiology. We report a 5-year-old boy with sarcoidosis who had an unusual presentation of membranous nephropathy and Budd-Chiari syndrome. These combinations of features have never reported in pediatric literature so far.
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Abstract
Sarcoidosis is an inflammatory disease characterized by non-caseating granulomas in the absence of other autoimmune processes, infectious diseases, or foreign agents. The etiology of sarcoidosis is not completely understood. Several organ systems can be affected, of which the most frequently involved include the lungs and lymph nodes. Intra-abdominal sarcoidosis is less common, but can be found in the absence of pulmonary or lymphatic disease. Intra-abdominal sarcoidosis is most often asymptomatic. However, long-standing unrecognized disease can result in life-threatening complications. The identification, monitoring and prevention of these complications will be discussed, with emphasis on both clinical and histological presentations of intra-abdominal sarcoidosis.
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13
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Delfosse V, de Leval L, De Roover A, Delwaide J, Honoré P, Boniver J, Detry O. Budd-Chiari syndrome complicating hepatic sarcoidosis: definitive treatment by liver transplantation: a case report. Transplant Proc 2010; 41:3432-4. [PMID: 19857764 DOI: 10.1016/j.transproceed.2009.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sarcoidotic involvement of the liver is frequent, albeit uncommonly symptomatic. Severe complications are rare, but may seldom require liver transplantation. Budd-Chiari syndrome has been described in a few patients with hepatic sarcoidosis. Herein we have reported the case of a young woman suffering from hepatic sarcoidosis who developed severe cholestasis and chronic Budd-Chiari syndrome. She successfully underwent orthotopic liver transplantation (OLT) and is asymptomatic with normal liver function at 3 years follow-up. Histopathological assessment of the liver explant demonstrated a florid granulomatous process, with involvement of the large intrahepatic veins, providing an anatomical basis for the vascular flow disturbances. This case adds further evidence that liver transplantation may be the curative treatment for complicated sarcoidotic liver disease.
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Affiliation(s)
- V Delfosse
- Department of Pathology, CHU de Liège, University of Liège, B4000 Liège, Belgium
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Ketari Jamoussi S, Mâamouri N, Ben Dhaou B, Baili L, Boussema F, Kochbati S, Cherif O, Ben Mami N, Rokbani L. L’atteinte hépatique au cours de la sarcoïdose : à propos de sept cas. Rev Med Interne 2010; 31:12-6. [DOI: 10.1016/j.revmed.2009.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 04/07/2009] [Accepted: 04/28/2009] [Indexed: 11/29/2022]
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15
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Maàmouri N, Ketari S, Habessi H, Nouira K, Ben Dhaou B, Boussema F, Cherif O, Ben Mami N, Rokbani L. [Budd-Chiari syndrome in sarcoidosis]. ACTA ACUST UNITED AC 2009; 33:147-8. [PMID: 19157737 DOI: 10.1016/j.gcb.2008.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 09/27/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
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