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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: dolanj@ohsu.edu
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.
Abstract
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.
