Hepatic and Gastric Involvement in a Case of Systemic Sarcoidosis Presenting with Rupture of Esophageal Varices

Abstract

A 46-year-old woman presented with massive hematemesis, caused by the rupture of esophageal varices. The laboratory investigations showed pancytopenia, and imaging tests revealed hepatosplenomegaly and ascites. A diagnosis of systemic sarcoidosis was made based on biopsies of the liver, stomach, lungs, heart, and skin. Although fat deposition was predominant, non-caseating granuloma and cirrhotic changes were found in the liver. Non-caseating granuloma was also identified in a biopsy specimen from minute depressions of the gastric folds. This case illustrates the rare involvement of the digestive system in a case of systemic sarcoidosis.

Keywords: esophagogastroduodenoscopy; gastric involvement; hepatic involvement; laparoscopy; systemic sarcoidosis.

Figure 1.

Photographs of the skin lesions. Well-demarcated, erythematous skin lesions are seen on the back (A) and legs (B).

Figure 2.

Radiological images of the abdomen. Contrast-enhanced CT scans of the arterial phase (A) and venous phase (B) show an enlarged liver with an irregular surface and splenomegaly. On MRI, multiple intrahepatic nodules are displayed as heterogeneous intensities in T1-weighed images (C) and as low intensities in T2-weighed images (D).

Figure 3.

Chest CT images. CT images show bilateral ground glass opacities in the lungs, in addition to marked lymphadenopathy in the mediastinum.

Figure 4.

Macroscopic and microscopic images of the liver. Laparoscopy reveals an irregular liver surface with huge, yellow nodules 3-4 cm in diameter (A, B). Pathological, non-caseating granulomas are identified (C). Moderate periportal fibrosis, regenerative nodules, and significant lipid collection is also noted (D).

Figure 5.

Esophagogastroduodenoscopy images. Varices are seen in the esophagus (A). In the stomach, multiple minute depressions on the gastric folds are seen in the upper gastric body (B). Multiple minute depressions are also noted in the middle-to-lower gastric body before (C) and after indigo carmine spraying (D). Non-caseating granulomas are identified in the stomach (E).