Biliary Sarcoidosis: Early Diagnosis Minimizes the Need for Surgery

Buxbaum, James; Papademetriou, Marianna; Klipfel, Nancy; Selby, Rick; Fong, Tse‐Ling; Sharma, Om P.

doi:10.1164/ajrccm.187.5.556

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…Features of large bile duct obstruction including portal edema, periportal ductular reaction, and associated neutrophils were also present. This finding may be due to either granulomatous inflammation involving larger bile ducts or granulomatous hilar lymphadenopathy resulting in extrahepatic bile duct obstruction, as typically seen in some cases of sarcoidosis [10]. Trichrome stain showed periportal fibrosis with few fibrous septa, as well as fibrosis around lobular granulomas.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Silicone Granulomas Secondary to Ruptured Breast Implants: A Report of Two Cases

Hudacko

Anand

Gordon

et al. 2019

Case Reports in Hepatology

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The differential diagnosis of hepatic granulomas is vast and includes infections, drugs, immunologic diseases, foreign material exposure, and neoplasia. Silicone, whether directly injected into tissues or used as a filler in breast implants, is known to cause localized granulomatous reactions. It can also migrate to other anatomic locations resulting in granulomatous inflammation at a distance. We report two cases of unsuspected hepatic silicone granulomas in patients undergoing liver biopsy for isolated elevated alkaline phosphatase levels, both with a history of ruptured breast implants. These cases highlight the need for awareness of hepatic silicone granulomas as an etiology of elevated liver enzymes in patients with a history of surgical interventions utilizing silica, such as cosmetic surgery.

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Section: Discussionmentioning

confidence: 99%

Hepatic Silicone Granulomas Secondary to Ruptured Breast Implants: A Report of Two Cases

Hudacko

Anand

Gordon

et al. 2019

Case Reports in Hepatology

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“…In neither case is there note of attempted corticosteroid treatment for sarcoidosis. Sitiropolos [11] and Buxbaum [14] also reported cases of sarcoidosis with similar PSC reminiscent findings.…”

Section: Discussionmentioning

confidence: 71%

“…In 2013 Buxbaum et al [11] described a case of a 42-yearold male who presented with jaundice and weight loss. His workup was notable for computed tomographic (CT) imaging showing biliary obstruction and high grade extrahepatic biliary duct obstruction seen on ERCP.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of biliary obstruction secondary to sarcoidosis

Hamby

Reizenman

Walker

2017

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Evaluation of the patient presenting with an elevated bilirubin often involves a study of the biliary tract for potential obstruction. Potential etiologies for obstruction of the common bile duct (CBD) include choledocholithiasis, pancreatic or ampullary neoplasm, cholangiocarcinoma, or extrinsic compression. Extrinsic compression can be from the gallbladder itself (Mirizzi's syndrome) or a neoplasm in adjacent lymph nodes. We describe an unusual cause of CBD obstruction -sarcoidosis; as well as the workup, and the laparoscopic treatment of regional sarcoidosis.

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“…Non-invasive (ie, MRI) and biliary tree imaging (ie, MRCP) demonstrate stricture or ‘beading’ of intrahepatic biliary ducts, and less commonly, extrahepatic involvement. 13 Interestingly, most reported cases proceed to Endoscopic retrograde cholangiopancreatography (ERCP) after a cross-sectional imaging modality. While more invasive, ERCP has the ability to obtain brush cytology in cases where cholangiocarcinoma is high on the differential.…”

Section: Discussionmentioning

confidence: 99%

Hepatic sarcoidosis resembling primary sclerosing cholangitis

2021

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We report the case of a 29-year-old man who presented with progressive weight loss, night sweats, abdominal pain and pruritus who was found to have obstructive jaundice and cholestatic pattern of liver injury on laboratory workup. Though findings on magnetic resonance cholangiopancreatography were initially concerning primary sclerosing cholangitis, he was ultimately diagnosed with biliary sarcoidosis after a liver biopsy. This case brings attention to the rare phenomenon of hepatic sarcoidosis causing hyperbilirubinemia and highlights the importance of reaching the correct diagnosis early, as the patient’s symptoms improved after initiation of steroids.

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Biliary Sarcoidosis: Early Diagnosis Minimizes the Need for Surgery

Cited by 17 publications

References 20 publications

Hepatic Silicone Granulomas Secondary to Ruptured Breast Implants: A Report of Two Cases

Hepatic Silicone Granulomas Secondary to Ruptured Breast Implants: A Report of Two Cases

Laparoscopic management of biliary obstruction secondary to sarcoidosis

Hepatic sarcoidosis resembling primary sclerosing cholangitis

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