Mueller S, Boehme M W, Hofmann W J, Stremmel W
Internal Medicine IV and Institute of Pathology, University of Heidelberg, Germany.
Scand J Gastroenterol. 2000 Sep;35(9):1003-8. doi: 10.1080/003655200750023110.
Sarcoidosis is a relatively common, chronic, multisystem disease of unknown origin characterized by the presence of noncaseating epithelioid granulomas. Although an array of organs may be affected by the disease, the commonest site of affection is the lung. We describe a 73-year-old patient admitted to our hospital because of fatigue, weight loss, and an increased alkaline phosphatase level. In conjunction with clinical presentation, laboratory variables, and imaging analysis, a liver biopsy finally confirmed the diagnosis of a systemic sarcoidosis without affection of the lung or mediastinal lymph nodes. Treatment with ursodeoxycholic acid before diagnosis did not improve clinical symptoms and cholestasis indicators. After prednisone treatment, liver enzyme values normalized and remained normal during follow-up for 2 years after diagnosis. The literature on hepatic manifestation of sarcoidosis, its diagnosis, treatment, and prognosis is reviewed. This single case of sarcoidosis presented to the clinician almost exclusively with liver enzyme abnormalities. The consideration of sarcoidosis in such cases is of utmost importance, since the differential diagnosis of hepatic granulomas includes infectious diseases in which treatment with corticosteroids could be fatal.
结节病是一种相对常见的慢性多系统疾病，病因不明，其特征是存在非干酪样上皮样肉芽肿。尽管该疾病可能累及一系列器官，但最常受累的部位是肺。我们描述了一名73岁的患者，因疲劳、体重减轻和碱性磷酸酶水平升高而入住我院。结合临床表现、实验室检查结果和影像学分析，肝活检最终确诊为系统性结节病，肺部和纵隔淋巴结未受累。诊断前使用熊去氧胆酸治疗并未改善临床症状和胆汁淤积指标。泼尼松治疗后，肝酶值恢复正常，诊断后2年的随访期间一直保持正常。本文回顾了结节病肝脏表现、诊断、治疗及预后的相关文献。这例结节病患者几乎仅表现为肝酶异常。在此类病例中考虑结节病至关重要，因为肝肉芽肿的鉴别诊断包括一些使用糖皮质激素治疗可能致命的传染病。
