Hepatic and gastrointestinal sarcoidosis

Hepatic or gastrointestinal involvement can be seen in around 18% of patients with sarcoidosis (1).

Liver involvement

• hepatic granulomas can be found in about 60% - 80% of liver biopsy specimens of patients with sarcoidosis (2). They are more common in patients with bilateral hilar lymphadenopathy alone rather than BHL plus pulmonary infiltrates
• usually clinically silent, may have constitutional symptoms such as fever, night sweats, anorexia, and weight loss. Liver enlargement is far less frequent (2,3)
• elevated serum aminotransferase and alkaline phosphatase levels are seen in around 10% of sarcoidosis patients (2)
• chronic intrahepatic cholestasis, hepatic dysfunction, cirrhosis and portal hypertension are extremely rare and severe complications of sarcoidosis (3)

Gastrointestinal tract

• gastrointestinal involvement is seen in less than 1% of patients
• stomach is the most involved part (3), gastric symptoms are uncommon. Granulomas are sometimes reported as incidental findings at post mortem in the stomach
• small intestine and colon sarcoidosis is uncommon but if present may mimic Crohn’s disease (3)
• splenic involvement presents with splenomegaly which is usually minimal and asymptomatic (3).

Reference:

• (1) Dempsey OJ et al. Sarcoidosis. BMJ. 2009 Aug 28;339:b3206
• (2) Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357(21):2153-65
• (3) Nunes H et al. Sarcoidosis. Orphanet J Rare Dis. 2007;2:46.