SHM Converge Scientific Abstract ePoster Gallery-Hepatic Sarcoidosis: A Golden Diagnosis

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This case describes a previously healthy 32-year-old man who presented with two weeks of jaundice and scleral icterus. He had no abdominal pain, gastrointestinal symptoms, fevers, weight loss, cough, or lymph node swelling. His only notable history was recent immigration from Venezuela after extensive travel through Central and South America, including river water exposure and contact with a family member later diagnosed with malaria/hepatitis.<br /><br />Initial labs showed a cholestatic and hepatocellular injury pattern: total bilirubin 8.0 mg/dL, AST 161, ALT 231, and markedly elevated alkaline phosphatase at 1248. RUQ ultrasound showed hepatomegaly with a heterogeneous, nodular liver contour. Given his travel history and the possibility of serious infection or malignancy, an extensive workup was pursued before considering immunosuppression.<br /><br />Infectious studies were negative, including cultures, hepatitis panel, HIV, TB testing, malaria, leptospira, leishmania, schistosoma, and other tests. Autoimmune and heme/onc evaluation was also unrevealing except for elevated ACE, ESR, and CRP. MRI/MRCP demonstrated widespread disease involving the liver, spleen, lungs, lymph nodes, and bone, raising concern for granulomatous systemic disease. Liver and lymph node biopsies showed extensive noncaseating granulomas with rare asteroid bodies, confirming sarcoidosis with hepatic involvement.<br /><br />The diagnosis was notable because jaundice is an uncommon standalone presentation of sarcoidosis. Hepatic sarcoidosis can be difficult to recognize due to its variable manifestations and may mimic infection, malignancy, or other inflammatory disorders. The case emphasizes the importance of a broad differential diagnosis and ruling out infectious causes before initiating long-term corticosteroid therapy.<br /><br />After steroid treatment, follow-up imaging showed improvement in hepatomegaly, splenomegaly, and associated lesions, supporting the diagnosis and demonstrating clinical response.

Asset Subtitle

Rachel Alter

Meta Tag

Author List Dimitra Xenopoulou, Leila Lotfi, Nooruddin Hashmi, Rachel Alter, Urian Kim

Category Clinical Vignettes

Concept Hepatic Sarcoidosis

Concept Noncaseating Granuloma

Concept Cholestatic Liver Injury Pattern

Concept Differential Diagnosis

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization Long Island Jewish Forest Hills Hospital

Presenting Author Rachel Alter

Track Adult

Keywords

sarcoidosis

hepatic sarcoidosis

jaundice

noncaseating granulomas

cholestatic liver injury

scleral icterus

granulomatous disease

corticosteroid therapy

hepatomegaly

systemic involvement

Hepatic Sarcoidosis

Noncaseating Granuloma

Cholestatic Liver Injury Pattern

Differential Diagnosis

Biopsy