P4705 - Case Series of Decompensated Cirrhosis in Patients With Systemic Sarcoidosis

Yadana Khin, MD¹, Fan Cao, BS^2
1MedStar Georgetown University Hospital, Washington, DC; ²Georgetown University School of Medicine, Washington, DC

Introduction: Sarcoidosis is a multiorgan inflammatory condition that can affect pulmonary, hepatic, renal, ocular, cutaneous, and neurological systems. Hepatic sarcoidosis is seen in 50% of systemic sarcoidosis cases with variable clinical manifestations. Decompensated cirrhosis also leads to multiorgan insult. We present two cases of decompensated liver cirrhosis in patients with known systemic sarcoidosis to highlight the complexities and importance of interdisciplinary management.

Case Description/Methods: Case 1:

A 49-year-old African American female with pulmonary and ocular sarcoidosis presented with newly diagnosed decompensated liver cirrhosis six months after her initial diagnosis of systemic sarcoidosis. One month later, she presented with cirrhosis acutely decompensated by ascites with spontaneous bacterial peritonitis, acute renal failure requiring dialysis, recurrent bleeding episodes, and intraperitoneal hematomas requiring embolizations. Due to her exponential decompensations, she required prolonged hospitalization and subsequently underwent spontaneous liver and kidney transplant within two months after her initial diagnosis of cirrhosis. Etiology of her liver cirrhosis was likely in the setting of hepatic sarcoidosis. Explant liver biopsy revealed bridging fibrosis with diffuse nodularity and hepatic necrosis, negative for granulomas.

Case 2:

A 43-year-old African American male with a history of pulmonary sarcoidosis, heart failure with reduced ejection fraction s/p ICD placement, end stage renal disease on hemodialysis, and extensive family history of sarcoidosis presenting with cirrhosis decompensated by ascites with spontaneous bacterial peritonitis. Liver biopsy showed distorted architecture with bands of thickened fibrosis with chronic portal inflammation without granulomas. Etiology of his cirrhosis was thought to be in the setting of chronic congestive hepatopathy. He was evaluated by a multidisciplinary team of hepatology, nephrology, cardiology, and rheumatology, however, given his multiple comorbidities, he was deemed to be a poor transplant candidate. A year later, he developed an infection of his ICD and passed away intraoperatively during the ICD removal procedure.

Discussion: Patients with systemic sarcoidosis can still develop cirrhosis of other etiologies and when this occurs, it adds a layer of complexity that requires multidisciplinary care coordination. Liver biopsies may not often show the classic findings of non-caseating granulomas once it has progressed to cirrhosis.


Disclosures:


Yadana Khin, MD¹, Fan Cao, BS². P4705 - Case Series of Decompensated Cirrhosis in Patients With Systemic Sarcoidosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.