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Lee, Kim, Kim, Song, Chung, Lee, Chang, Kang, Choi, Park, and Lee: A Case of Sarcoidosis Combined with Massive Ascites
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(6): 364-368.

Published online: 31 December 2012

DOI: https://doi.org/10.4078/jrd.2012.19.6.364

A Case of Sarcoidosis Combined with Massive Ascites

Su Jin Lee1, Eun Hye Kim1, Young Sook Kim1, Je Eun Song1, Soo-Jin Chung2, Chun Kyun Lee2, Myung Hee Chang2, Jung Gu Kang3, Yoon Jung Choi4, Su Mi Park5, Chan Hee Lee2

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

3Department of Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

4Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

5Department of Radiology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

Corresponding to: Chan Hee Lee, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, 100, Ilsan-ro, Ilsandong-gu, Goyang 410-719, Korea. chanheell@paran.com

Received 2 January 2012       Revised 29 February 2012       Accepted 3 March 2012

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Sarcoidosis is a multi-systemic granulomatous disease of unknown cause, which most commonly involves lung, skin, eye, liver and lymph nodes. Herein, we report a case of sarcoidosis presented with massive ascites. A 47-year-old male patient visited our hospital with symptoms of general weakness and weight loss from past 4 months. Abdomen computed tomography showed multiple lymphadenopathy and hepatosplenomegaly. Lymph node biopsy demonstrated non-caseating granulomas. After biopsy, development of massive uncontrolled ascites was noted. Liver biopsy showed non-cirrhotic hepatic and portal fibrosis and omental biopsy showed submesothelial diffuse fibrosis and focal chronic inflammation, which were suggestive of hepatic and peritoneal involvement in sarcoidosis. Ascites was controlled after subsequent treatment with corticosteroids and methotrexate.

Keywords: Sarcoidosis, Massive ascites, Liver involvement, Peritoneal involvement, Methotrexate

Figures and Tables

Figure 1
(A) Abdominal pelvic CT image shows hepatosplenomegaly and multiple enlarged lymph nodes at the hepatoduodenal ligament (white arrows). (B) Coronal CT image shows newly developed large amount of ascites. (C) CT image shows newly appeared surface nodularity of the liver, suggesting diffuse liver disease and nearly complete resolution of hepatosplenomegaly and lymphadenopathy. (D) CT image shows complete improvement of large amount of ascites and no interval change of hepatosplenomegaly after one-year of the treatment.
jrd-19-364-g001
Figure 2
(A) Lymph node biopsy shows non-caseating granulomas and vascular sinus transformations by reactive change (H & E stain, ×40). (B) Liver biopsy shows non-cirrhotic hepatic and portal fibrosis (Trichrome stain, ×100).
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