P2885 - Sarcoidosis Manifesting as Liver Granuloma With Asteroid Bodies

Adel Muhanna, MD¹, Laith Al Momani, MD², Alisa Likhitsup, MD^2
1University of Missouri Kansas City School of Medicine, Kansas City, MO; ²University of Missouri Kansas City, Kansas City, MO

Introduction: Sarcoidosis is an autoimmune disease which most commonly affects the lungs and lymph nodes and characterized with non-caseating granulomas. It has an estimated prevalence of 10 cases per 100,000 population worldwide. Herein, we present the case of a 59-year-old man with sarcoidosis presenting with abnormal laboratory tests.

Case Description/Methods: A 59-year-old man was evaluated for an elevation of alkaline phosphatase. The patient has a past medical history significant for diabetes mellitus, sarcoidosis, cardiomyopathy, non-Hodgkin’s lymphoma, and hypertension. The patient is a non-smoker, and he denied any significant alcohol or drug use or known liver disease in himself or his family members. Upon physical exam, the patient was well-appearing, he had no apparent jaundice, abdominal pain, and was in no apparent distress. Laboratory data revealed a hemoglobin of 11.6 g/dL, white blood cell count of 12 K/μL, and a platelet count of 535 K/μL. Other liver enzymes levels were normal with an AST levels of 27 U/L, ALT levels of 29 U/L, an albumin level of 3.7 g/dL, and a total bilirubin level of 0.2 mg/dL. His alkaline phosphatase level was 230 U/L. Liver enzyme levels of the patient obtained two months ago were normal. The patient tested negative viral hepatitis, ANA, ASMA, AMA, and his A1AT and ceruloplasmin levels were normal. Computed topography of the abdomen and pelvis with IV Contrast of the liver showed a mildly enlarged liver with an extensive inhomogeneous uptake of FDG throughout the liver. Ultrasound-guided liver biopsy was done which showed steatosis, steatohepatitis, and focal portal granuloma formation with asteroid body, and increased periportal and bridging fibrosis (Figure A). Iron, PAS, and PAS-D staining of the liver were negative. Following liver biopsy, the patient was scheduled regular liver enzymes for follow up, and he was also scheduled repeat abdominal imaging in six months to monitor the liver closely.

Discussion: Hepatic involvement in sarcoidosis occurs in about 12% of patients with sarcoidosis, and patients are usually asymptomatic and might only have laboratory abnormalities at the time of presentation. The progression to liver cirrhosis or cholestatic liver disease in patients with sarcoidosis is less than 1%. Liver biopsy is usually recommended and might show non-necrotizing along the portal tract. Our case also illustrates the characteristic asteroid bodies of sarcoidosis found in the liver



Disclosures:


Adel Muhanna, MD¹, Laith Al Momani, MD², Alisa Likhitsup, MD². P2885 - Sarcoidosis Manifesting as Liver Granuloma With Asteroid Bodies, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.