Critical Care: Fellow Case Report Poster - Critical Care II |

Obstructive Jaundice: The Sarcoidosis Way FREE TO VIEW

Hammad Arshad, MD; Meilin Young, MD; Rajashekar Adurty, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):250A. doi:10.1016/j.chest.2016.08.263
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SESSION TITLE: Fellow Case Report Poster - Critical Care II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidosis is a granulomatous disease of unknown cause that affects multiple organ systems.Although rare, hepatic sarcoidosis can occur and lead to the development of cirrhosis.

CASE PRESENTATION: A 47 year old male with past medical history significant for recurrent pancreatitis and pseudocyst,hypertension,diabetes mellitus and pulmonary sarcoidosis presented to our hospital with vague complaints of nausea,vomiting,abdominal pain and yellowish discoloration of his eyes.Workup showed elevated liver enzymes with a total bilirubin of 9. His CT scan showed fatty liver with no abnormality of the hepatobiliary tree.He subsequently had an ERCP performed that showed a biliary stricture for which he had a stent placed. His bilirubin continued to increase after the procedure to 18.1 and was subsequently placed on steroids.His bilirubin and symptoms subsequently improved and he was discharged. Patient eventually underwent a planned outpatient cholecystectomy due to recurrent symptoms with liver biopsy. Biopsy showed chronic cholecysitis and severe steatohepatitis with stage III fibrosis with portal granulomas, consistent with sarcoidosis. The patient eventually was diagnosed to have Child C liver cirrhosis and died from complications of portal hypertension and decompensated liver failure.

DISCUSSION: Sarcoidosis is a systemic inflammatory disease process resulting in the abnormal collections of inflammatory cells to form non-caseating granulomas that may involve any organ. Although more than 90% of cases of sarcoidosis affect the thoracic lymph nodes and the lung , abdominal visceral organs may also be involved without any clinical manifestation . Symptomatic liver disease occurs in less than 5% of patients with sarcoidosis due to chronic intrahepatic cholestasis and jaundice. Cirrhosis and portal hypertension occur in fewer than 1% of cases of hepatic sarcoidosis. Early liver biospsy and prompt management with steroids can prevent the progression of granulomatous inflammation to end stage liver disease.

CONCLUSIONS: Hepatic sarcoidosis, although rare, should remain high on the differential in patients with known history of saroidosis who present with complications associated with a hepatobiliary origin.

Reference #1: Robert P. Baughman et al “A Concise Review of Pulmonary Sarcoidosis“, American Journal of Respiratory and Critical Care Medicine, Vol. 183, No. 5 (2011), pp. 573-581.

Reference #2: Gupta, S et al , Sarcoidosis complicated by cirrhosis and hepatopulmonary syndrome. Canada Respiratory Journal. 2008 Apr; 15(3): 124-126

DISCLOSURE: The following authors have nothing to disclose: Hammad Arshad, Meilin Young, Rajashekar Adurty

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