Abstract
We report the case of a 48-year-old male with a history of pulmonary and ocular sarcoidosis. Non-caseating granulomas, identified histologically, are the most characteristic manifestation of sarcoidosis. Hepatic sarcoidosis is difficult to diagnose using radiological imaging. In the patient reported in this study, ultrasound and contrast-enhanced computed tomography scans identified multiple intra-abdominal lymphadenopathies, with evidence of liver and splenic infiltrations. The first liver biopsy revealed non-caseating granulomatous hepatitis consistent with hepatic sarcoidosis. The patient was treated with ursodeoxycholic acid (UDCA), but his laboratory parameters did not improve. Prednisone was initiated at a dose of 30 mg daily and slowly tapered. At a dose of 12.5 mg daily, marked improvements in the fibrotic and sarcoid-like lesions were noted at the second biopsy. A third biopsy was performed, with the patient on a prednisone taper of 5 mg/day showed mild fibrous expansion in the portal tracts and mild parenchymal necro-inflammatory lesions. However, overall, fibrosis marker levels remained stable over the course of treatment. A fourth biopsy was performed after a 5-year course of 5 mg/day prednisone. This revealed minimal lobular inflammation without fibrosis. Thus, treatment of this patient with corticosteroids and UDCA resulted in marked improvements in his biochemical and histological parameters.
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The authors would like to thank the Department of Gastroenterology and Hepatology and the Department of Pathology at Nara Medical University. The authors would also like to thank Enago for the English language editing.
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The first draft of the manuscript was written by MK and reviewed and edited by TN. All authors reviewed previous drafts and read and approved the final manuscript.
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12328_2023_1918_MOESM1_ESM.pptx
Fig. S1 (A) Chronological course of contrast-enhanced abdominal computed tomography of a 48-year-old Japanese man with hepatic sarcoidosis. The liver was grossly enlarged with numerous low-contrast nodules in the left and right lobes. The spleen was markedly enlarged and multiple hypointense nodules were apparent after contrast injection. (B) Chronological course of computed tomography of the lung of a 48-year-old Japanese man with hepatic sarcoidosis (PPTX 4198 KB)
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Kikuchi, M., Koizumi, A., Namisaki, T. et al. Improvement of liver histology in hepatic sarcoidosis due to treatment with corticosteroids and ursodeoxycholic acid: a case report. Clin J Gastroenterol 17, 327–333 (2024). https://doi.org/10.1007/s12328-023-01918-3
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DOI: https://doi.org/10.1007/s12328-023-01918-3