Hypertensive Workup Leading to the Discovery of Hepatic Sarcoidosis

Abstract

Introduction: Sarcoidosis is a systemic disease of unknown etiology that affects many organs, including the liver. It is usually asymptomatic and manifests as nonspecific biological disturbances. It is characterized by the presence of granulomatous, non-caseating lesions in the affected organs. Although it is most often revealed by mediastinal-thoracic involvement, such as pulmonary infiltrates or mediastinal adenopathies, or by skin and eye involvement, liver involvement is an infrequent site. Objectif: To report the case of a young man, presenting with high blood pressure figures, who consulted for etiological assessment of arterial hypertension which was at the origin of a rare form of sarcoidosis. Case report: The patient was 49 years old and had recently discovered hypertension as a cardiovascular risk factor, with no particular pathological history. On admission, the patient reported a 16 kg weight loss with anorexia. Biologically, hepatic cytolysis was noted with the presence of cholestasis with GGT and PAL at twice the normal level. The bilirubin level was normal. The rest of the workup, hydrolytic, protein, renal blood and urine, as well as the hemogram were without abnormality. The etiological workup of this cytolysis was negative for viral serology, and the immunological workup for chronic liver disease was negative. While the dosage of angiotensin converting enzyme was high at 93.8 units per liter. On the imaging plan, the abdominal ultrasound was normal, a complement by abdominal scanner found a slightly heterogeneous aspect of the right liver with a coelio-mesenteric ganglion of 27x13 mm, the abdominal MRI made objectified. In view of this, we indicated that a liver biopsy should be performed for etiological purposes and to evaluate the fibrosis. The anatomopathological examination was in favor of a gigantocellular epithelioid granuloma without caseous necrosis evoking sarcoidosis. Discussion and conclusion: Liver involvement in sarcoidosis is ........