J Rheum Dis.  2012 Dec;19(6):364-368. 10.4078/jrd.2012.19.6.364.

A Case of Sarcoidosis Combined with Massive Ascites

• Lee SJ
• Kim EH
• Kim YS
• Song JE
• Chung SJ
• Lee CK
• Chang MH
• Kang JG
• Choi YJ
• Park SM
• Lee CH

• KMID: 2223066
• DOI: http://doi.org/10.4078/jrd.2012.19.6.364

Abstract

Sarcoidosis is a multi-systemic granulomatous disease of unknown cause, which most commonly involves lung, skin, eye, liver and lymph nodes. Herein, we report a case of sarcoidosis presented with massive ascites. A 47-year-old male patient visited our hospital with symptoms of general weakness and weight loss from past 4 months. Abdomen computed tomography showed multiple lymphadenopathy and hepatosplenomegaly. Lymph node biopsy demonstrated non-caseating granulomas. After biopsy, development of massive uncontrolled ascites was noted. Liver biopsy showed non-cirrhotic hepatic and portal fibrosis and omental biopsy showed submesothelial diffuse fibrosis and focal chronic inflammation, which were suggestive of hepatic and peritoneal involvement in sarcoidosis. Ascites was controlled after subsequent treatment with corticosteroids and methotrexate.

Keyword

Sarcoidosis; Massive ascites; Liver involvement; Peritoneal involvement; Methotrexate

MeSH Terms

Abdomen
Adrenal Cortex Hormones
Ascites
Biopsy
Eye
Fibrosis
Granuloma
Humans
Inflammation
Liver
Lung
Lymph Nodes
Lymphatic Diseases
Male
Methotrexate
Sarcoidosis
Skin
Weight Loss
Adrenal Cortex Hormones
Methotrexate

Figure

• 

  Figure 1 (A) Abdominal pelvic CT image shows hepatosplenomegaly and multiple enlarged lymph nodes at the hepatoduodenal ligament (white arrows). (B) Coronal CT image shows newly developed large amount of ascites. (C) CT image shows newly appeared surface nodularity of the liver, suggesting diffuse liver disease and nearly complete resolution of hepatosplenomegaly and lymphadenopathy. (D) CT image shows complete improvement of large amount of ascites and no interval change of hepatosplenomegaly after one-year of the treatment.

• 

  Figure 2 (A) Lymph node biopsy shows non-caseating granulomas and vascular sinus transformations by reactive change (H & E stain, ×40). (B) Liver biopsy shows non-cirrhotic hepatic and portal fibrosis (Trichrome stain, ×100).

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