ECG indicated a normal heart rhythm at 85 beats/min. A Holter ECG showed nine premature supraventricular contractions and no premature ventricular contractions. Transthoracic echocardiography showed no abnormality. A chest CT scan showed isolated BHL. Pulmonary function test results indicated normal respiratory function. Bronchoscopy findings were normal, but a bronchial biopsy specimen showed noncaseating granuloma. BAL fluid showed a slightly elevated lymphocyte number and a high CD4/CD8 cell ratio (8.35). Because of her abdominal symptoms and elevated alkaline phosphatase level, an abdominal CT scan was performed, which showed no liver abnormality but multiple nodules on the peritoneum, mimicking peritoneal carcinomatosis (Fig 1
). Findings of a standard endoscopic diagnostic evaluation (ie, eosophagogastroduodenoscopy with small-bowel biopsy and ileocolonoscopy and endovaginal ultrasonography) were normal. Laparoscopy was carried out with a biopsy of the liver and peritoneal nodules (Fig 2
). Histologic findings in all specimens (from peritoneal, liver, and bronchial biopsies) were similar, consisting of multiple, well-formed, noncaseating granulomas that were composed of aggregates of tightly clustered epithelioid cells with some giant cells without central necrosis. A liver biopsy showed moderate inflammatory activity in the lobular and periportal areas, and grade 1 septal fibrosis. The results of special staining and cultures for mycobacteria in all biopsy specimens, including peritoneal biopsy specimens, BAL fluid, and sputum were negative. The patient was discharged from the hospital with a diagnosis of Löfgren syndrome associated with liver and peritoneal involvement by sarcoidosis, with no treatment prescribed except for iron supplementation and a nonsteroidal antiinflammatory drug. At the follow-up 6 months after hospital discharge, the patient was completely asymptomatic, and physical examination findings were normal. Liver enzyme levels, erythrocyte sedimentation rate, and C-reactive protein level had returned to normal ranges, while the level of angiotensin-converting enzyme remained elevated at 103 UI/L. A CT scan of the chest, abdomen, and pelvis showed no change.