2329 Recurrent Hepatic Sarcoidosis in Post-Liver Transplant

Abstract

INTRODUCTION: Sarcoidosis is a systemic disease that is characterized by presence of non-caseating granulomas which can affect multiple organ systems which include lungs, eyes and skin. Involvement of the liver is common in sarcoidosis but typically patients are asymptomatic and as a result underdiagnosed. Abnormalities of liver enzymes is seen only in thirty five percent of patients. Only one percent of these patients will progress to end stage liver disease requiring orthotopic liver transplant (OLT). This is a unique case of recurrent sarcoidosis in a patient who was compliant with anti-rejection immunosuppressive medication and had a recurrent flare of sarcoidosis in the liver fou years after transplant. CASE DESCRIPTION/METHODS: We present a case of a 59-year-old African American lady with medical history remarkable for DM2, psoriasis, and systemic sarcoidosis s/p OLT 4 years ago for hepatic sarcoidosis presented to the emergency department for increasing abdominal pain. She is complaint with her immunosuppressive medications, which included prednisone, tacrolimus and mycophenolate. Work-up showed hypercalcemia, which prompted imaging. Imaging showed typical changes for systemic sarcoidosis consistent with retroperitoneal and pelvic adenopathy. A liver biopsy was prompted which showed both cirrhosis and granuloma formation consistent with sarcoidosis. She was discharged with a significant increase in immunosuppressive medications especially her prednisone after an appropriate response in her liver chemistries. She follows with hepatology clinic for long-term care of her liver sarcoidosis. DISCUSSION: This is a unique case of recurrent sarcoidosis in a patient who was compliant with medication including steroids and had a recurrent flare of sarcoidosis in the liver 4 years after OLT. According to our review of literature there has only been a handful of cases of hepatic sarcoidosis following OLT. Most of these reports involved the recurrence of sarcoidosis within 8 months and up to 5 years ,but most of them had early cessation of steroids. Recurrent hepatic sarcoidosis is a rare occurrence which likely under diagnosed. Future studies implementing protocol liver biopsies in this population could lead to the discovery of the true prevalence along with further insights into the prevention of recurrent disease long-term.