Course of asymptomatic liver involvement in sarcoidosis: role of therapy in selected cases

Abstract

Aim: Although granulomatous involvement of the liver with functional abnormalities is widely known, the course of these abnormalities is not clearly known. The study was designed to find out the incidence and course of asymptomatic liver function abnormalities.

Methods: From 1990-1995, during the five year period, 44 (35.2%) of 125 patients with sarcoidosis at LAC + USC Medical Center had liver involvement. Liver enzyme abnormalities aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (AP) were taken as criteria for liver involvement: 41 (93%) patients had elevated AP, 22 (50%) showed elevated ALT, and 24 (54.5%) had elevated AST.

Results: 25 of 44 patients received treatment; 12 (48%) showed improvement in liver enzymes and 13 (52%) remained unchanged. Ten (7%) of 13 patients, who did not receive any treatment, also improved. During the same period at USC University Hospital 18 (25%) of 72 had liver involvement. Twelve patients received treatment; 6 (50%) patients showed improvement in liver enzymes. One of 3 patients, who did not receive treatment, improved. 5 (41%) developed complications due to steroids.

Conclusion: Liver involvement is common in African American patients with sarcoidosis. Social and economic status do not seem to influence the liver involvement. In men the age distribution has an early peak. The outcome of patients who receive treatment remains similar, as far as liver function is concerned, suggesting that most of the patients with liver involvement undergo natural remission. Unless the patient has progressive liver dysfunction, it is advisable to monitor liver enzymes periodically and obtain liver biopsies only if clinically indicated. In patients who need treatment, it is reasonable to try options other than steroids in view of severe corticosteroid related complications.