Sarcoidosis Masquerading as Long-Standing Cholestasis
| Autor: | Smit Deliwala, Rupesh Khanal, Anoosha Ponnapalli, Mamoon M Elbedawi, Hemant Goyal, Murtaza Hussain, Adil Abdalla |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Cholestasis Cirrhosis business.industry Extrapulmonary medicine.medical_treatment Case Report Immunosuppression Liver transplantation medicine.disease Gastroenterology Sarcoid Liver disease Liver Internal medicine Hepatocellular carcinoma Transaminitis medicine Alkaline phosphatase Sarcoidosis business |
| Zdroj: | Gastroenterology Research |
| ISSN: | 1918-2813 1918-2805 |
| DOI: | 10.14740/gr1360 |
| Popis: | Hepatic sarcoidosis is an exceedingly rare extrapulmonary manifestation of sarcoidosis, with the majority remaining stable for years without clinical clues, only displaying biochemical abnormalities. Amongst the literature, the timeline to cirrhosis has not been parsed out; hepatomegaly develops in 50% and cirrhosis in 33% of all hepatic sarcoidosis patients, making this an essential issue in this patient population. Interestingly, the risk for hepatocellular carcinoma remains high regardless of cirrhosis development. Corticosteroids and biologics remain the mainstay of therapy, although refractory cases may require deeper immunosuppression. Liver transplantation is seen in a handful of cases with promising results. We present an interesting case of cholestatic pattern livery injury in our outpatient setting that was eventually discovered to be hepatic sarcoidosis. Mild biochemical derangements or sole elevations in alkaline phosphatase are under-recognized, and patients often progress to cirrhosis and end-stage liver disease. This diagnostic miss has significant implications and represents an opportunity to treat liver disease with a reversible cause. Consensus guidelines recommend alkaline phosphatase screening in newly diagnosed cases of sarcoidosis. |
| Databáze: | OpenAIRE |
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