Sarcoidosis of the liver

Sarcoidosis can affect the liver when granulomas form in hepatic tissue. Many people have no symptoms, while others may develop fatigue, discomfort in the upper right abdomen, itching, jaundice or an enlarged liver and spleen. Advanced disease can lead to biliary fibrosis or cirrhosis, although this is uncommon.

Possible complications

1. Portal hypertension is increased pressure in the portal venous system. It may occur because of biliary fibrosis or cirrhosis and is more likely in advanced disease. Symptoms may include ascites (fluid in the abdomen) and bleeding from enlarged veins (varices) in the gastrointestinal tract.

2. Cirrhosis is advanced scarring (fibrosis) of the liver and is usually permanent. It occurs in fewer than 1% of cases of hepatic sarcoidosis. Symptoms may include fatigue, bleeding and bruising, itchy skin, jaundice, ascites, loss of appetite and confusion (hepatic encephalopathy).

Diagnosis

The symptoms described above are assessed with one or more of the following tests:

• Liver function tests may show an increased serum alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT).
• A liver biopsy can confirm granulomas in the liver.
• CT may show granulomas (small areas of inflammation) in the liver and signs of cirrhosis, such as a small nodular liver.

Treatment

Most people with sarcoidosis have a mild form and do not require treatment. Up to 75% improve without corticosteroids, while the remainder remain stable.

Corticosteroid treatment may be needed in advanced cases. It can improve liver-function test results and relieve symptoms, but the optimal duration of treatment is not clear. Everyone with cirrhosis should be referred to a hepatologist or gastroenterologist.

Liver transplantation is a valid option for people with decompensated liver disease, for example when ascites, hepatocellular carcinoma (HCC) or gastrointestinal bleeding develops.

Liver ACE values

ACE means angiotensin-converting enzyme.

Reference interval: 16–68.

Serum ACE levels are elevated in about 40% of people with sarcoidosis, depending on the time since diagnosis, acute or chronic disease, disease extent, radiological stage and many other factors. However, an elevated ACE level is not specific to sarcoidosis. Increased values may also occur, for example, when a liver lesion develops.

This information is educational and does not replace a medical examination or advice from a healthcare professional.