Hepatic Sarcoidosis in a Patient with Chronic Hepatitis B Virus Infection

Hye-Sun Park; Hyemin Kim; Ji-Yeon Lee; Su-Young Jung; Seunghee Han; Yong-Beom Park; Soo-Kon Lee; Sang Hoon Ahn; Sang-Won Lee

doi:10.4078/jrd.2015.22.3.200

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

Case Report

J Rheum Dis 2015;22(3):200-204.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.3.200

Hepatic Sarcoidosis in a Patient with Chronic Hepatitis B Virus Infection

Hye-Sun Park¹, Hyemin Kim², Ji-Yeon Lee¹, Su-Young Jung¹, Seunghee Han¹, Yong-Beom Park³, Soo-Kon Lee³, Sang Hoon Ahn^1,⁴, Sang-Won Lee³

¹Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

²Department of Pathology, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

³Division of Rheumatology, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

⁴Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

Corresponding to: Sang-Won Lee, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. E-mail: sangwonlee@yuhs.ac

Received 9 June 2014 Revised 11 August 2014 Accepted 19 August 2014

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 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.

Keywords: Sarcoidosis, Hepatitis B virus, Liver cirrhosis, Portal hypertension

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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.

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).

Figure 3.

Positron emission tomography scan with multiple uptakes in the liver, spleen, lymph nodes, and bones.

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.

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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