• BMJ case reports · Dec 2019

    Case Reports

    Extrapulmonary sarcoidosis primarily presenting as cholestatic liver disease.

    • Pieter De Mulder, Bert Maertens, Anne Hoorens, and An Vonck.
    • Internal Medicine, Ghent University, Gent, Belgium pieter.de.mulder@hotmail.com.
    • BMJ Case Rep. 2019 Dec 4; 12 (12).

    AbstractSarcoidosis is a multisystem inflammatory disorder associated with non-caseating granulomas in affected organs, most commonly the lungs. Involvement of extrapulmonary organs is common, but lack of pulmonary involvement is rare and is called non-pulmonary sarcoidosis (NPS). Like pulmonary sarcoidosis, a definitive diagnostic test for NPS does not exist. Instead, the diagnosis of sarcoidosis requires the following elements: clinical and radiographic manifestations of sarcoidosis, histopathological detection of non-caseating granulomas and the exclusion of other diseases that may present similarly. Because of the experience with corticosteroids in pulmonary sarcoidosis, they are generally considered first-line therapy for NPS too. Ursodeoxycholic acid can be used to reduce cholestasis in NPS, but is inferior to corticosteroids in reducing inflammation. We hereby present a case that is particularly notable for its rare presentation of NPS as a granulomatous hepatitis with cholestatic liver function tests.© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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