Hepatic sarcoidosis: clinical and diagnostic aspects

Abstract

Introduction. Hepatic sarcoidosis (HS) is a complicated aspect of sarcoidosis, an inflammatory disease with unknown causes, marked by the formation of non-caseating granulomas in various organs. The liver is a frequent site for sarcoidosis, ranked after the lungs and lymph nodes. Aim of Study: To analyze the various clinical and diagnostic aspects of Hepatic sarcoidosis. Material and methods. The study is based on the assessment of articles and guidelines sourced between 2014 to 2024 from PubMed, Elsevier and Wiley Online Library with the use of the keywords such as hepatic sarcoidosis, granulomas, clinical manifestations. Results. Liver involvement was seen in 4.2% of sarcoidosis patients, in which 14.5% are clinically significant. Clinical symptoms range from asymptomatic lesions with normal liver tests to cirrhosis and portal hypertension. The primary symptoms are abdominal pain, jaundice and pruritus. Most common indicator is an elevated alkaline phosphatase level. Ultrasound examination, abdominal CT, and MRI findings in those patients may easily be confused with other liver pathologies such as primary biliary cholangitis, tuberculosis, drug induced liver injury, malignant lymphoma, viral hepatitis or other liver diseases. On biopsy, hepatic sarcoidosis can be diagnosed by the presence of non-caseating hepatic granulomas and multinucleated giant cells. Conclusions. Hepatic sarcoidosis is a critical area of study due to its challenging diagnosis and lack of treatment guidelines. Since it mimics the symptoms and similarities of other liver diseases, the best method to distinguish this pathology is biopsy. Biopsy serves as the cornerstone in diagnosing hepatic sarcoidosis.