Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Case Report

Volume 14, Number 2, April 2021, pages 112-115

Sarcoidosis Masquerading as Long-Standing Cholestasis

Figures

Figure 1.
Figure 1. Computed tomography (CT) of the abdomen revealing changes consistent with cirrhosis and splenomegaly.
Figure 2.
Figure 2. Hematoxylin and eosin-stained histological examination at × 20 magnification revealing non-caseating granulomas (arrows) in the left lower lung.
Figure 3.
Figure 3. Hematoxylin and eosin-stained histological examination at × 40 magnification revealing epithelioid histiocytes, lymphocytes, and multinucleated giant cells in the left lower lung.
Figure 4.
Figure 4. Diff-Quik stained histological examination at × 20 magnification revealing epithelioid histiocytes and lymphocytes (arrows) from the left hilar lymph nodes.

Table

Table 1. Laboratory Values at Baseline and After 3 Months of Treatment With Corticosteroids
 
Laboratory investigative markerBaseline valuesThree months after treatment
Alkaline phosphatase (ALP)1,556 U/L572 U/L
ALP isoenzymesLiver 76%, bone 24%, intestinal 0%, and placental 0%N/A
Aspartate aminotransferase (AST)172 U/L41 U/L
Alanine aminotransferase (ALT)210 U/L66 U/L
Total bilirubin1.9 mg/dL1.3 mg/dL
Total protein7.7 g/dL5.9 g/dL
Albumin3.8 g/dL3.1 g/dL
Globulin3.9 g/dL2.8 g/dL
International normalized ratio (INR)0.92 s< 0.89 s
Alpha-fetoprotein (AFP)2.1 ng/mLN/A
Gamma-glutamyl transferase (GGT)545 U/LN/A
Carcinoembryonic antigen (CEA)< 0.5 ng/mLN/A
Liver fibrosis serum panelScore: 0.73, stage: F3/F4 advanced fibrosisN/A
Vitamin D (1,25(OH)D)> 156 pg/mLN/A
Model for end-stage liver disease sodium (MELD-Na)11 points9 points
Bronchoalveolar lavage (BAL) cell countMacrophages 93%, neutrophils 1%, eosinophils 1%, and lymphocytes 6%N/A