Hepatic and mesenteric sarcoidosis without thoracic involvement: a case of severe noncirrhotic portal hypertension and successful pregnancy
| Autor: | Giancarlo Vannozzi, Guido Chibbaro, Alessandro Tozzi, Giorgio Mello, Massimo Ponzalli |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Abdominal pain Cirrhosis Sarcoidosis Gastroenterology Cholestasis Pregnancy Internal medicine Hypertension Portal Mesenteric Vascular Occlusion Ascites Humans Medicine Contraindication Hepatology business.industry Liver Diseases Infant Newborn Pregnancy Outcome medicine.disease Surgery Pregnancy Complications Portal hypertension Female Liver function medicine.symptom business Magnetic Resonance Angiography |
| Zdroj: | European Journal of Gastroenterology & Hepatology. 20:1032-1035 |
| ISSN: | 0954-691X |
| Popis: | Here we report a case of a 25-year-old woman with mesenteric and hepatic sarcoidosis without lung involvement complicated by severe noncirrhotic portal hypertension. In 1992, at the clinical presentation, she had abdominal pain, asthenia, and weight loss. Splenomegaly, signs of flogosis, sideropenic anemia, and cholestasis were observed. Laparoscopic abdominal exploration and histological analysis demonstrated noncaseating granulomas of the liver, abdominal lymph nodes, and mesenteric connective tissue. The clinical course was severe with episodic remissions and recrudescences characterized by ascites (mild or moderate), elevation of bilirubin levels (mean: 1.1 mg/dl; range: 0.9-3.5 mg/dl), reduction of albumin levels (mean: 4 g/dl; range: 3.4-4.2 g/dl), and prolongation of elevated international normalized ratio (mean: 1; range: 0.9-1.4). In 1997, the patient had variceal bleeding. Complete hemostasis was obtained with band ligation. Liver function was preserved, and until 2000 the disease remained stable. In 2001, the patient became pregnant. At the 36th week of gestation, the patient delivered a healthy female infant and afterwards remained in clinical remission. This report stresses that sarcoidosis can have a hepatic and mesenteric involvement in absence of thoracic lymphadenopathy. Portal hypertension may be severe, and in absence of cirrhosis it may be associated with portal thrombosis. Finally, portal hypertension in patients with hepatic sarcoidosis and preserved liver function should not be considered as an absolute contraindication to pregnancy. |
| Databáze: | OpenAIRE |
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