P4774 - Sarcoid Beyond the Lungs

Leandro Gutierrez, MD¹, Miguel Agudelo, MD², Shari Forbes, MD^2
1Newark Beth Israel Medical Center, Union, NJ; ²Newark Beth Israel Medical Center, Newark, NJ

Introduction: Sarcoidosis is a disease that affects many systems, with the most common being the pulmonary system. However, approximately 40-50% of patients will experience extra-thoracic sarcoidosis which include the lymph nodes, the hepatic system, the spleen and stomach to name a few. Of those cases, 11-80% will be hepatic sarcoidosis (HS). The majority of patients with HS are asymptomatic and few will present with non-specific symptoms such as fatigue, fevers, arthralgias. More specific symptoms can include jaundice, pruritus and right upper quadrant pain. We present this case of hepatic sarcoidosis as it is under recognized and has the potential to be under diagnosed as most cases are usually found incidentally. Diagnosis requires laboratory testing, such as liver function tests, serum angiotensin converting enzyme (ACE) levels, histology and clinical signs. However, there are reports to suggest that less than 20% of patients will have clinically significant disease.

Case Description/Methods: Our patient is a 58-year-old female who arrived from Brazil with complaints of lower back pain radiating to the right flank and groin as well as chest pain. Laboratory values demonstrated moderate hypercalcemia. Imaging revealed a lingular consolidation, mediastinal and mesenteric adenopathy, an enlarged nodular liver with splenomegaly, and nephrolithiasis bilaterally without obstruction. The patient’s hospital course consisted of treatment of streptococcal pneumonia with bacteremia and hypercalcemia without complication. She was later found to have elevated 1,25 Vitamin D1 and ACE levels. Given our suspicion for sarcoidosis, a liver biopsy was performed with pathology reporting numerous non-necrotic granulomas in the portal tracts and fibrous septa. Special stains for AFB and fungal organisms were done to rule out other potential causes of her granulomas, all of which were negative. She was subsequently started on steroids and advised to follow-up in the clinic for continued management.

Discussion: In this case we highlight how sarcoidosis, a disease most commonly associated with lung involvement, can present initially with extrathoracic manifestations. This brings attention to the rare condition of hepatic sarcoidosis, its diagnostic perplexity and highlights the wide array of clinical presentations of this complex entity.


Disclosures:


Leandro Gutierrez, MD¹, Miguel Agudelo, MD², Shari Forbes, MD². P4774 - Sarcoid Beyond the Lungs, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.