Granulomatous Disease with Hepatic and Splenic Infiltration: A Case Report
Molly Conroy and James Dolan*
Department of Surgery and The Digestive Health Center, Oregon Health and Science University, USA
- Corresponding Author:
- James P. Dolan, MD
Department of Surgery and The Digestive Health Center
Oregon Health and Science University
3303 SW Bond Avenue, Portland
Oregon 97239, USA
Tel: (503) 494-9767
Fax: (503) 494-8884
E-mail: [email protected]
Received Date: July 15, 2014; Accepted Date: August 20, 2014; Published Date: August 27, 2014
Citation: Conroy M, Dolan J (2014) Granulomatous Disease with Hepatic and Splenic Infiltration: A Case Report. J Gastroint Dig Syst 4:210. doi:10.4172/2161-069X.1000210
Copyright: © 2014 Conroy M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A 42 year old woman underwent a Computed Tomography (CT) scan after developing respiratory symptoms in the setting of a previous pulmonary embolus. It showed diffuse infiltrates of the right lung lobe, atelectatic changes of the left lung lobe, and multiple hypodense lesions of the liver and spleen. A diagnosis of lymphoma or a chronic opportunistic infection was entertained. Tumor markers and serum studies showed only an elevated ß-2 microglobulin. Positron Emission Tomography (PET) was performed and demonstrated multiple foci of uptake in the liver, spleen, mediastinum, supraclavicular and axillary areas. A bone marrow biopsy demonstrated no abnormal findings. She underwent a diagnostic laparoscopy for biopsy. Final pathology of the liver lesions showed noncaseating granulomatous inflammation suggestive of sarcoidosis. The patient began corticosteroids treatment and was in remission at 9 month follow-up. The prevalence of hepatic granuloma in sarcoidosis depends on the population studied and on the procedure used for obtaining the liver specimen. It has been reported in up to 80% of cases in some series. A recurrence after at least one year in remission affects less than 5% of patients but when it occurs it can develop at any age and in any organ. Corticosteroids remain the mainstay of therapy, despite the lack of well-controlled clinical trials to show that these agents improve patients' long-term outcome.