[Sarcoidosis and liver involvement: a case series of 25 patients]

Abstract

Purpose: Sarcoidosis is a systemic disease of unknown etiology that may affect many organs including the liver. Our aims were to determine the clinical, paraclinical and therapeutic characteristics of patients with liver sarcoidosis and to compare, on the one hand, the revealing hepatic involvement to the non-revealing form and, on the other hand, sarcoidosis with and without liver disease.

Methods: A retrospective and descriptive study over 14 years of 25 patients with liver involvement selected from 56 cases of systemic sarcoidosis.

Results: The study population was composed of 18 females and seven males. The mean age was 48.2 years. Liver involvement was the presenting manifestation in 56% of cases. The functional history was dominated by general signs and abdominal pain. Hepatomegaly was present in ten patients. Biological abnormalities were identified in 84% of the cases with cholestasis (80%) and cytolysis (36%). Abdominal tomography showed hepatomegaly in 68.4% of the patients. Hepatic impairment was histologically confirmed in 16 patients. Granulomas were located in portal region (18.8%), in lobular region (12.5%) and in both (56.2%). Necroinflammatory lesions were found in 56.2%, cholestatic lesions in 18.8% and vascular lesions in 6.3%. Portal fibrosis and cirrhosis were seen in 25% and 6.3%, respectively. Twenty-four patients were treated with corticosteroids with 1 mg/kg per day (66.7%) and 0.5 mg/kg per day (33.3%). Under treatment, the response was complete in 81% and partial in 9.5%. One patient had no response. The liver involvement was significantly associated with general signs, renal failure and lymphopenia. Abdominal pain, hepatomegaly and lymph node were significantly associated with the revealing form.

Conclusion: Liver involvement is frequent in sarcoidosis and commonly asymptomatic. Hepatomegaly is the most common clinical sign. Biological disturbance are present in 20 to 40% of the patients. The treatment is based essentially on corticosteroid therapy.