Hepatic sarcoidosis treatment

Renal adenocarcinoma has been reported in a 50-year-old man after 3 years of cyclophosphamide treatment for hepatic sarcoidosis (54). 

Kennedy PT, Zakaria N, Modawi SB, et al. Natural history of hepatic sarcoidosis and its response to treatment. Eur J Gastroenterol Hepatol 2006 18 721-726. 

Most patients with hepatic sarcoidosis do not require treatment (81). Although treatment with corticosteroids can improve liver function tests in approximately half of asymptomatic patients, three-fourths of such patients who are not treated eventually undergo spontaneous improvement in liver function tests and the rest remain stable (59). Furthermore, evidence suggests that corticosteroid treatment of hepatic sarcoidosis promotes relapse (87). On the basis of these data, therapy for hepatic sarcoidosis is not indicated in asymptomatic patients with Uver function test elevations. Such patients should be followed with serial Uver function tests, although it is rare for them to develop hepatic failure (59). 

As mentioned previously, patients with hepatic sarcoidosis may develop a chronic cholestatic syndrome with jaundice, fever, malaise, anorexia, weight loss, pruritus, and a cholestatic pattern of abnormal Uver function tests (77-79). These symptoms are often severe and require treatment. Prednisone in doses of 30 to 60 mg/day may improve symptoms, lower serum alkaline phosphatase levels, and improve hepatomegaly (77,96). Ursodeoxycholic acid, which inhibits intestinal absorption and increases biliary secretion of cholic and chenodeoxycholic acids (97), is often effective for the cholestatic syndrome of hepatic sarcoidosis (98,99). A dose of 10 mg/kg/day has been recommended (98,99). 

Lu CL, Chen CY, Hou MC, et al. The experience of endoscopic tissue glue injection in the treatment of hepatic sarcoidosis related gastric variceal bleeding report of a case. Hepato-gastroenterol 1999 46 2293-2295. 

De novo sarcoidosis has been reported in six patients (357-361) and reactivation of pre-existing disease in one (362). One of these patients had chronic hepatitis B, suggesting that interferon alfa treatment rather than the underlying disease was the most probable triggering factor. Remission was observed in all patients after withdrawal, either spontaneously or after glucocorticoid treatment. 

Cogrel O, Doutre MS, Marliere V, Beylot-Barry M, Couzigou P, Beylot C. Cutaneous sarcoidosis during interferon alfa and ribavirin treatment of hepatitis C virus infection two cases. Br J Dermatol 2002 146(2) 320-4. 

Nawras A, Alsolaiman MM, Mehboob S, Bartholomew C, Maliakkal B. Systemic sarcoidosis presenting as a granulomatous tattoo reaction secondary to interferon-alpha treatment for chronic hepatitis C and review of the literature. Dig Dis Sci 2002 47(7) 1627-31. 

Hurst EA, Mauro T. Sarcoidosis associated with pegylated interferon alfa and ribavirin treatment for chronic hepatitis C a case report and review of the Utera-ture. Arch Dermatol 2005 141(7) 865-868. 

Low-dose methotrexate, 10 to 25 mg a week, is used for the treatment of cutaneous sarcoidosis (42). Cutaneous improvement may be noted within one month, but maximal therapeutic benefit often does not occur until at least six months after the initiation of treatment. The drug requires careful monitoring of liver function tests and blood cell counts. Folic acid is recommended to be given in conjunction with methotrexate. Approximately 10% of sarcoidosis patients taking methotrexate develop hepatic fibrosis, even if their serum liver function tests are normal (43). Therefore liver biopsies should be considered after two grams of total therapy (usually after two years) (43). 

Granulomatous hepatitis from sarcoidosis may require treatment if patients develop fever, nausea, vomiting, pruritus weight loss, or right upper-quadrant abdominal pain (67). Corticosteroids are usually effective in alleviating these symptoms (67,93). Many patients require a daily dose of prednisone in the 10 to 15 mg range. Therapy is often required for more than one year (67). Despite the potential risk of hepatic toxicity from methotrexate, it has been shown to be effective, reduce liver function test abnormalities, and to be corticosteroid sparing (67,95). 

Cacopardo B, Pinzone MR, Nunnari G. Development of sarcoidosis during treatment for chronic hepatitis C with pegylated interferon alfa-2a and ribavirin case report and literature review. Infez Med 2013 21(l) 40-4. 

---

See also in sourсe #XX -- [ ]

---