A case of sarcoidosis liver caused rupture of esophageal varices due to sudden portal hypertension

Abstract

A 44-year-old female patient, visited a near-by ophthalmologist with a chief complaint of photophobia in 2011 and was diagnosed with uveitis. She was referred to our department of respiratory medicine for further evaluation and was diagnosed with pulmonary sarcoidosis. However, since no respiratory disturbances were observed, the patient was kept on for follow-up observation. In March 2012, emergency endoscopy was conducted due to melena and hematemesis, and a diagnosis of rupture of esophageal varices. Subsequently, endoscopic variceal sclerotherapy was conducted. The endoscopy performed five months prior to the event did not show varices. The observation from the abdominal CT and MRI was consistent with that of hepatic sarcoidosis. A laparoscopic liver biopsy was taken and the diagnosis was confirmed histologically as hepatic sarcoidosis. We assumed that the sudden progression of hepatic sarcoidosis led to portal hypertension and this has caused the rapid formation and rupture of hepatic sarcoidosis. Oral steroid was administered for prevention because the findings from the pathological tissue indicated a risk of developing cirrhosis. Five months later have blood biochemical test results showed improvement. © 2013 The Japan Society of Hepatology.