An Unusual Hepatic Origin of Fever and Weight Loss – A Case Report

Background: Sarcoidosis is a chronic multiorgan inflammatory condition with a wider variety of clinical presentations histologically characterised by non-caseating granulomas in the affected organ. Lung and lymph nodes are the most commonly involved organs, followed by liver, spleen, skin, eyes, heart and the nervous system. Although hepatic sarcoidosis is associated with pulmonary involvement, isolated hepatic disease is rare. Here we report a 37 year old gentleman, presenting with low grade intermittent fever, loss of appetite and 10kg weight loss in 9 months. Biochemical evaluation showed ALT 70 (20-47 U/L), ALP 402 (50-180 U/L), GGT 332 (19-50 U/L), bilirubin 0.9 mg/dl, Albumin 2.3 mg/dl, and INR 1.2. His abdominal imaging elsewhere showed multiple heterogenous areas in the liver diagnosed as cirrhosis and was referred to us for further management. A percutaneous liver biopsy showed multiple non caseating granuloma suggestive of sarcoidosis. His ACE level was elevated. He was started on corticosteroids following which there was dramatic improvement in clinical, biochemical and radiological parameters.