An interesting presentation of hepatic sarcoidosis

Background and Aim: Sarcoidosis is a systemic disease which affects multiple organ systems. Liver involvement found in 11%-80% patients. Case Report: 28, male, presented to the OPD, with chief complaints of unintentional weight loss >35kg 1 year, anorexia, nausea, vomitingsince 2 months. On examination, patient was emaciated Virchows node palpable. Hb-11.2, creatinine-2.3, SGOT- 854, SGPT- 367, ALP- 667. Calcium high at 10.3mg/dl. Patient admitted for further evaluation. Initial suspicion lymphoma vs Tuberculosis. PET CT done revealed supra-clavicular, mediastinal, abdomino-pelvic lymph node, enlarged spleen, deposits liver mass gastro-esophageal junction. GEJ biopsy nonspecific inflammatory polyp. BM turned out normal. Chromosomal analysis normal karyotype. SCN-biopsy non caseating granuloma, confluent epitheloid histiocytes, Langhans giant cells. Lymphoma ruled out, based on clinical presentation inconclusive histologic findings, diagnosis TB considered. AKT-4 started. A follow up scan after month mild reduction size some nodes but no major changes were seen deposits/splenomegaly. Post months AKT-4, there little response from patient. Serum ACE levels sent 83mg/dl (high). accordingly started oral prednisolone ursodeoxycholic acid. AKT stopped. After month, considerable patient, he improved considerably. Results: This rare case multisystem sarcoidosis hepatic who had an atypical presentation. The extreme loss, along presence nodes, GEJ-mass caused confusion between TB. However, it important rule other causes infiltrative disorder before considering common cause like or lymphoma.