The silent voice of the liver in a systemic disease. Case study of hepatic sarcoidosis

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown etiology that may, in atypical cases, involve the liver. Hepatic manifestations are often subtle, heterogeneous, and nonspecific, which can mislead clinicians and delay an accurate diagnosis. Liver biopsy with histological examination remains the gold standard for diagnosis, playing a critical role in confirming hepatic sarcoidosis. We report the case of a 43-year-old female patient admitted to the hepatology department with persistent right upper quadrant pain and fatigue. Biochemical analysis revealed a cytolytic and cholestatic pattern, while complete blood count showed anemia and thrombocytosis. Viral, tumor, and autoimmune liver markers were within reference ranges. Abdominal ultrasound and computed tomography (CT) revealed hepatomegaly. Hematologic malignancies were ruled out. The diagnosis of hepatic sarcoidosis was established by histopathological examination of a liver biopsy. Considering the frequent association with pulmonary sarcoidosis, a thoracic CT scan was performe which revealed mediastinal lymphadenopathy. The patient was subsequently referred to the pulmonology team, where immunosuppressive therapy was initiated, with favorable clinical and laboratory evolution. This case highlights an unusual presentation of hepatic involvement in systemic sarcoidosis. It underscores the importance of a multidisciplinary approach to achieve timely diagnosis and initiate appropriate pathogenetic treatment, particularly in the presence of unexplained hepatic abnormalities.