title: Clinical presentation and protocol for management of hepatic sarcoidosis.
abstract: The liver is one of the most commonly involved extrapulmonary sites in sarcoidosis. Hepatic sarcoidosis has a broad range of presentations from scattered, asymptomatic noncaseating granulomas with normal liver enzymes, which are very common in patients with known pulmonary sarcoidosis, to portal hypertension and cirrhosis, which are relatively uncommon. Diagnosis is based on a combination of clinical, laboratory and histological manifestations. The authors' protocol for management of patients with suspected sarcoidosis of the liver without focal lesions includes a transjugular liver biopsy with portal pressure measurements to confirm the diagnosis, rule out coexisting liver diseases and to identify select patients with fibrosis or portal hypertension for consideration of immunosuppression. Steroids and azathioprine are the preferred agents and methotrexate is not recommended.
authors.affiliation: Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
authors.forename: Jamak
authors.initials: J
authors.lastname: Modaresi Esfeh
authors.forename: Daniel
authors.initials: D
authors.lastname: Culver
authors.forename: Thomas
authors.initials: T
authors.lastname: Plesec
authors.forename: Binu
authors.initials: B
authors.lastname: John
mesh_terms: D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D017082:Portal Pressure; D012507:Sarcoidosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: clinical presentation; hepatic; management; review; sarcoidosis