Nodules hépato-spléniques d’évolution spontanément favorable au cours d’une sarcoïdose

Margery, J.; Bonnichon, A.; Vaylet, F.; Bredin, Christian; L'her, P.; Revel, T. De

doi:10.1016/s0761-8417(07)90110-8

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…Independently of the localization, in half of cases, disease resolves spontaneously within 2 years [ 8 ]. Likewise, isolated histological lesions do not imply the startup of a corticosteroid treatment, hepatic and splenic locations discovered incidentally on imaging may have an evolution spontaneously favorable [ 11 ]. On the other hand, debate exists about whether treatment can change the outcome of sarcoidosis, particularly fibrosis [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatic sarcoidosis: a case series

et al. 2016

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Sarcoidosis is a systemic non caseous granulomas disease. Liver is a common location but usually asymptomatic. Evidence based guidelines for this location treatment is lacking and the effect of corticosteroids may be inadequate. The aim of our study was to describe the clinical, biochemical, radiological and therapeutic features of seven patients with systemic sarcoidosis and liver involvement. A retrospective and descriptive monocentric study, over 3 years, including seven patients with systemic sarcoidosis and liver involvement. We included 5 women and 2 men with an average age of 43 years. Hepatic localization revealed sarcoidosis in 5 cases. Hepatomegaly was observed in all patients as well as abnormal serum liver function test reflected by anicteric cholestasis. Liver biopsy, showed in all granulomatous lesions consistent with sarcoidosis and severe fibrosis in 2 cases. Extra-hepatic manifestations were present in all patients represented mainly by pulmonary location. All patients were treated, five by corticosteroid and two with ursodeoxycholic acid (UDCA). Complete response was observed in one case, partial response in another case and corticosteroid refractoriness in one case. In two cases, corticosteroid therapy was introduced for less than 1 month, not allowing assessment of response. Antimalarials in combination with UDCA were used successfully in a patient with steroid-resistant liver disease. Liver involvement can reveal systemic sarcoidois. Given the risk of progression to severe liver disease, it must be screened in all patients with systemic sarcoidosis. Treatment is not systematic, and still based on corticosteroid therapy. In the absence of prospective randomized controlled trials, the efficacy of UDCA need to be proven.

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Section: Discussionmentioning

confidence: 99%

Hepatic sarcoidosis: a case series

et al. 2016

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“…Le TEP-scanner au 18 FDG ne permet pas de différencier les diagnostics (187). Dans la mesure où l'atteinte hépatosplénique est asymptomatique, elle n'impose pas de traitement, d'autant plus que les régressions spontanées sont possibles (188). Une splénectomie peut être indiquée en cas de doute diagnostique (189,190) ou en cas de complications (191).…”

Section: Manifestations Cliniques Et Paracliniquesunclassified

Sarcoïdose osseuse : étude rétrospective de 27 cas

Glanowski

Chapelon-Abric

Mestiri

et al. 2015

La Revue de Médecine Interne

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Atteinte hépatosplénique symptomatique révélatrice d’une sarcoïdose systémique

Bouomrani

Baïli

Nouma

et al. 2015

J Afr Hepato Gastroenterol

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Les localisations hépatospléniques symptomatiques inaugurales de sarcoïdose sont exceptionnelles. Nous rapportons l'observation d'une patiente de 47 ans, non tarée qui fut admise pour bilan étiologique d'un ictère cutanéo-muqueux d'aggravation progressive associé à un prurit géné-ralisé et évoluant depuis un mois. L'examen physique trouvait en plus de l'ictère cutanéo-muqueux franc, une hépato-splénomégalie ferme, irrégulière et indolore. La biologie montrait une cholestase et une cytolyse hépatique modérée sans signes d'insuffisance hépatocellulaire. L'imagerie médicale notait une hépato-splénomégalie hétérogène sans lésions focales ni adénopathies profondes associées. La biopsie hépatique montrait une hépatite granulomateuse non nécrosante et le bilan étiologique de cette granulomatose concluait à une sarcoïdose. Sous corticothérapie systémique l'évolution était favorable cliniquement, biologiquement et radiologiquement.Une meilleure connaissance de ces localisations ainsi que leur détection précoce se trouvent justifiées car influencent la stratégie thérapeutique et conditionnent le pronostic de cette granulomatose.Mots clés Sarcoïdose · Hépato-splénomégalie · Granulomatose · Imagerie · Cholestase Abstract Inaugural symptomatic hepatosplenic locations of sarcoidosis are exceptional. We report the case of a 47 years old patient without medical history who was explored for progressive worsening mucocutaneous jaundice, associated with generalized pruritus, and lasting for one month. Physical examination revealed mucocutaneous jaundice associated to an irregular and painless hepatosplenomegaly. Biology showed cholestasis and moderate hepatic cytolysis without signs of liver failure. Medical imaging noted heterogeneous hepatosplenomegaly without focal lesions or deep lymph nodes. Liver biopsy showed necrotizing granulomatous hepatitis and etiological investigation for this granulomatosis concluded to systemic sarcoidosis. Under corticosteroids the evolution was favorable clinically, biologically and radiologically.A better understanding of these locations as well as their early detection are justified because they influence the therapeutic strategy and determine the prognosis of this granulomatosis.

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Nodules hépato-spléniques d’évolution spontanément favorable au cours d’une sarcoïdose

Cited by 5 publications

References 7 publications

Hepatic sarcoidosis: a case series

Hepatic sarcoidosis: a case series

Sarcoïdose osseuse : étude rétrospective de 27 cas

Atteinte hépatosplénique symptomatique révélatrice d’une sarcoïdose systémique

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