Journal List > J Rheum Dis > v.22(3) > 1064192

Park, Kim, Lee, Jung, Han, Park, Lee, Ahn, and Lee: Hepatic Sarcoidosis in a Patient with Chronic Hepatitis B Virus Infection

Abstract

Sarcoidosis is a systemic inflammatory granulomatous disease affecting multiple organs, including liver, spleen, heart, eyes, and skin. Liver involvement is reported in 11.5% of cases and many studies have reported on the association between hepatitis C virus infection and sarcoidosis. However, the role of hepatitis B virus (HBV) infection as a trigger for sarcoidosis has never been reported. We describe a case of hepatic sarcoidosis in a patient with chronic hepatitis B infection, with a possible link between the two. It is the first case report of a patient with interferon-α-naïve chronic HBV infection presenting with hepatic sarcoidosis accompanied by portal hypertension and liver cirrhosis.

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Figure 1.
Abdomen sonogram (A) and abdomen computed tomography (CT) scan (B). Sonogram (A) reveals coarse parenchymal echogenicity of the liver. CT scan (B) shows heterogeneous enhancement in the enlarged liver and the spleen.
jrd-22-200f1.tif
Figure 2.
Liver biopsy showing the non-caseating granuloma (arrows) (A) and asteroid body (B). Special staining for acid fast bacilli (AFB) (C) and periodic acid Schiff (PAS) (D) were negative (A: H&E, ×100; B: H&E, ×400; C: AFB, ×400; D: PAS, ×400).
jrd-22-200f2.tif
Figure 3.
Positron emission tomography scan with multiple uptakes in the liver, spleen, lymph nodes, and bones.
jrd-22-200f3.tif
Figure 4.
Chest computed tomography (CT) scans (A, B) and abdominal CT scans (C, D). CT scans at the time of diagnosis (A, C) showing multiple perilymphatic nodules in both lungs (arrows) and heterogeneous enhancement in liver and spleen with hepatosplenomegaly. CT scans (B, D) taken after steroid treatment, revealing near total resolution of perilymphatic nodules and decreased size of liver and spleen.
jrd-22-200f4.tif
Table 1.
Laboratory data
Variable Patient's result Reference range
White cell count (/μ L) 2,940 4,000∼10,800
Hemoglobin (g/dL) 11.8 12.0∼16.0
Platelet count (/μ L) 119,000 150,000∼400,000
Prothrombin time (s) 12.10 9.2∼12.3
ESR (mm/h) 12.0 0.0∼20.0
AST (IU/L) 44 13.0∼34.0
ALT (IU/L) 22 5.0∼46.0
Total protein (g/dL) 8.7 6.0∼8.0
Albumin (g/dL) 3.2 3.3∼5.3
Total bilirubin (mg/dL) 0.7 0.4∼1.5
Gamma-GT (IU/L) 175 7.0∼35.0
LDH (IU/L) 277 119∼247
ALP (IU/L) 296 32∼93
HBs Ag Positive Negative
HBe Ag Negative Negative
Anti HBe Positive Negative
HBV-RQ PCR (IU/mL) 60.3 <20
Anti HCV Negative Negative

Ag: antigen, ALP: alkaline phosphatase, ALT: alanine transaminase, AST: aspartate transaminase, ESR: erythrocyte sedimentation rate, GT: glutamyl transpeptidase, HBe: hepatitis B e, HBs: hepatitis B surface, HBV: hepatitis B virus, HCV: hepatitis C virus, LDH: lactate dehydrogenase, RQ PCR: real-time quantitative polymerase chain reaction.

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