Sarcoidosis with granulomatous hepatitis and autoimmune endocrine involvement.

Dear Editor, Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases. The lungs, eyes, skin, abdominal organs, central nerve system and bones are among the organs involved.1,2 Although non-caseous granulomas are detected histopathologically in the involvement of the liver in sarcoidosis, the values obtained from liver function test are generally normal. Hepatomegaly and retroperitoneal adenopathy are most frequently seen even though radiological evidence in sarcoidosis-related granulomatous hepatitis is rare.2,3 Sarcoidosis may also be related to endocrine autoimmune diseases. Autoimmune thyroiditis accompanying sarcoidosis has been reported in the literature; however, the combination of sarcoidosis with other autoimmune diseases is not frequent.4,5 Autoimmune diseases such as type 1 diabetes mellitus (DM) and Hashimoto’s thyroiditis, elevation of the liver function test values and granulomatous hepatitis with hepatomegaly were observed to accompany sarcoidosis in our case. To our knowledge, no other sample cases with all these components have been reported in the literature. A 50-year-old female patient complaining of backache and fatigue was admitted to our clinic due to elevation of liver function test values. The patient had undergone total abdominal hysterectomy and bilateral salpingooophorectomy 6 years prior to this presentation. She was diagnosed with type 1 diabetes mellitus 25 years ago and has had Hashimoto’s thyroiditis, osteoporosis and fibromyalgia for 3 years. A high-resolution computed tomographic (CT) scan, obtained in February 2004 due to dyspnoea, revealed a ground-glass appearance in the lungs. Open lung biopsy was performed and the diagnosis of sarcoidosis was made. One-year methlyprednisolone therapy was started. She weighed 74 kg and her height was 1.7 m. Her blood pressure was 100/80 mmHg. The thyroid gland palpated heterogeneously. Incision scars of approximately 10 cm extending from the left anterior axillary line to the posterior axillary line and a median infra-umbilical incision of approximately 15 cm were noted. The liver was palpable approximately 5 cm below the costal margin. There were numerous subdermal nodules, and the biggest of which was 1 x 1 cm in the right upper and lower extremities. Laboratory investigations revealed the following – fasting glucose level: 228 mg/dL, total cholesterol: 279 mg/dL, Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement