Natural history of hepatic sarcoidosis and its response to treatment

Abstract

Sarcoidosis can cause end-stage chronic liver disease, which is often unrecognized until examination of the explanted liver. Response to conventional immunosuppression is variable and unpredictable. Transplantation is feasible and safe in this population but recurrence is possible.

Extrapulmonary sarcoidosis of liver and pancreas: A case report and review of literature

“…The frequency of exclusive liver involvement without lung disease in patients with systemic sarcoidosis is infrequent and seen in only 13% of patients with sarcoidosis [5] . Our patient presented with derangement of liver function.…”

“…In asymptomatic patients or those with mild lung disease, the side effects of systemic steroids often exceed the benefits of treatment [6] , and the disease may spontaneously remit. In the literature, there are only a few reports on treatment of liver sarcoidosis [5,73,74] . These cases demonstrate that liver function may improve even though liver granulomas may persist on histology.…”

“…Sarcoidosis can also coexist with these two entities. Cirrhosis [5,45,46] and portal hypertension [39,40,45,47,48] are only found in 1% of patients with sarcoidosis. Furthermore, extrahepatic biliary tract obstruction [37] in sarcoidosis from enlarged granulomatous lymph nodes has been described, but this was not the case in our patient.…”

“…Nevertheless, the exact time point of treatment, dosage, and benefits versus side effects are still controversial [5,[66][67][68][69][70][71][72] . Because sarcoidosis has such varied manifestations, severity, and course, there have been no valid prospective placebo-controlled treatment trials.…”

“…Exclusive liver involvement without lung disease is less frequent, documented in only about 13% of patients with systemic sarcoidosis [5] . The diagnosis of liver sarcoidosis is difficult, because symptoms or functional derangement due to involvement of the liver are uncommon in sarcoidosis [6] .…”