胃腸および消化器系

抽象的な

Granulomatous Disease with Hepatic and Splenic Infiltration: A Case Report

Molly Conroy and James Dolan

A 42 year old woman underwent a Computed Tomography (CT) scan after developing respiratory symptoms in the setting of a previous pulmonary embolus. It showed diffuse infiltrates of the right lung lobe, atelectatic changes of the left lung lobe, and multiple hypodense lesions of the liver and spleen. A diagnosis of lymphoma or a chronic opportunistic infection was entertained. Tumor markers and serum studies showed only an elevated ß-2 microglobulin. Positron Emission Tomography (PET) was performed and demonstrated multiple foci of uptake in the liver, spleen, mediastinum, supraclavicular and axillary areas. A bone marrow biopsy demonstrated no abnormal findings. She underwent a diagnostic laparoscopy for biopsy. Final pathology of the liver lesions showed noncaseating granulomatous inflammation suggestive of sarcoidosis. The patient began corticosteroids treatment and was in remission at 9 month follow-up. The prevalence of hepatic granuloma in sarcoidosis depends on the population studied and on the procedure used for obtaining the liver specimen. It has been reported in up to 80% of cases in some series. A recurrence after at least one year in remission affects less than 5% of patients but when it occurs it can develop at any age and in any organ. Corticosteroids remain the mainstay of therapy, despite the lack of well-controlled clinical trials to show that these agents improve patients' long-term outcome.