Sarcoidosis of the Liver – An underdiagnosed entity

Background Sarcoidosis is a multisystem disorder primarily affecting the lungs. Hepatic manifestations occur in 10-65%, ranging from asymptomatic cases to severe complications like chronic cholestasis, portal hypertension, or cirrhosis. Due to its varied presentation, hepatic sarcoidosis is assumed to be underdiagnosed.

Methods Using ICD codes, 35 patients from a university hepatology center with clinically and/or histologically confirmed liver involvement in sarcoidosis were identified. Clinical characteristics were recorded at initial diagnosis, after three and twelve months.

Additionally, a second cohort of 356 sarcoidosis patients from a pulmonology center was examined for abnormal liver values or imaging findings.

Results In the first cohort, 20% (n=7) of patients with hepatic sarcoidosis showed isolated liver involvement, while 74.2% (n=26) had 2-5 organs affected. Common symptoms were fever (28.6%) and weight loss (25.7%), with 17.1% (n=6) being asymptomatic. In 62.9% (n=22), liver involvement was biopsy-proven, but only 40% (n=14) showed a morphological correlate in imaging. Laboratory results predominantly showed a cholestatic pattern with elevated ALP and gamma-GT. Glucocorticoids were used in 51.4% (n=18), 42.9% (n=15) received no therapy.

In the second cohort, 47.8% (n=170) of pulmonary sarcoidosis patients showed abnormal liver values or imaging.

Conclusion The first cohort data indicate that biopsy-confirmed liver manifestations can exist without imaging correlate. Self-limiting courses are possible, if necessary, glucocorticoids, immunosuppressants, or UDCA for cholestasis are used.

The high number of liver abnormalities in the second cohort suggests that hepatic sarcoidosis is underdiagnosed. Therefore, liver involvement should be ruled out in sarcoidosis patients. Screening using ALP levels is recommended.

Publication History

Article published online:
20 January 2025