A Comprehensive Review of Hepatic Sarcoid

Abstract

Sarcoidosis is a multisystem inflammatory disease, which is characterized by the development of noncaseating granulomas amid healthy tissue. While most commonly affecting the mediastinum and/or lungs, sarcoid can also affect the liver, resulting in “hepatic sarcoid.” The spectrum of disease in hepatic sarcoid is variable, ranging from asymptomatic or mild liver enzyme abnormalities to end-stage liver disease requiring liver transplantation. Because clinically-significant hepatic sarcoid is rare, research on epidemiology, clinical manifestations, and treatment is limited. The mainstays of hepatic sarcoid treatment have involved steroids and more recently, ursodeoxycholic acid; however, novel immunomodulatory agents provide new possibilities for management. Questions remain regarding screening, diagnostic modalities, and what to treat with and when. The purpose of this review is to summarize the available research on the epidemiology, clinical course, and management of hepatic sarcoid, and identify gaps in our knowledge to motivate future research.

Keywords

hepatic sarcoid - granulomatous hepatitis - liver sarcoid - sarcoidosis - ursodeoxycholic acid

• References

• 1 Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007; 357 (21) 2153-2165
• 2 Hu Y, Yibrehu B, Zabini D, Kuebler WM. Animal models of sarcoidosis. Cell Tissue Res 2017; 367 (03) 651-661
• 3 Hunninghake G, Costabel U, Ando M. , et al. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160 (02) 736-755
• 4 Judson MA, Boan AD, Lackland DT. The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29 (02) 119-127
• 5 Baughman RP, Teirstein AS, Judson MA. , et al; Case Control Etiologic Study of Sarcoidosis (ACCESS) research group. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001; 164 (10 Pt 1): 1885-1889
• 6 Mañá J, Rubio-Rivas M, Villalba N. , et al. Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain. Medicine (Baltimore) 2017; 96 (29) e7595
• 7 Ungprasert P, Crowson CS, Matteson EL. Epidemiology and clinical characteristics of sarcoidosis: an update from a population-based cohort study from Olmsted County, Minnesota. Reumatismo 2017; 69 (01) 16-22
• 8 Ungprasert P, Crowson CS, Simonetto DA, Matteson EL. Clinical characteristics and outcome of hepatic sarcoidosis: a population-based study 1976-2013. Am J Gastroenterol 2017; 112 (10) 1556-1563
• 9 Mayock RL, Bertrand P, Morrison CE, Scott JH. Manifestations of sarcoidosis: analysis of 145 patients, with a review of nine series selected from the literature. Am J Med 1963; 35: 67-89
• 10 Markevitz N, Epstein Shochet G, Levi Y, Israeli-Shani L, Shitrit D. Sarcoidosis in Israel: clinical outcome status, organ involvement, and long-term follow-up. Lung 2017; 195 (04) 419-424
• 11 Ebert EC, Kierson M, Hagspiel KD. Gastrointestinal and hepatic manifestations of sarcoidosis. Am J Gastroenterol 2008; 103 (12) 3184-3192 , quiz 3193
• 12 Tadros M, Forouhar F, Wu GY. Hepatic sarcoidosis. J Clin Transl Hepatol 2013; 1 (02) 87-93
• 13 Thomeer M, Demedts M, Wuyts W. , et al. Epidemiology of sarcoidosis. Eur Respir Monogr 2005; 31: 13-22
• 14 Pietinalho A, Hiraga Y, Hosoda Y, Löfroos AB, Yamaguchi M, Selroos O. The frequency of sarcoidosis in Finland and Hokkaido, Japan: a comparative epidemiological study. Sarcoidosis 1995; 12 (01) 61-67
• 15 Hägerstrand I, Linell F. The prevalence of sarcoidosis in the autopsy material from a Swedish town. Acta Med Scand Suppl 1964; 425: 171-174
• 16 Gideon NM, Mannino DM. Sarcoidosis mortality in the United States 1979-1991: an analysis of multiple-cause mortality data. Am J Med 1996; 100 (04) 423-427
• 17 Swigris JJ, Olson AL, Huie TJ. , et al. Sarcoidosis-related mortality in the United States from 1988 to 2007. Am J Respir Crit Care Med 2011; 183 (11) 1524-1530
• 18 Reid JD. Sarcoidosis in coroner's autopsies: a critical evaluation of diagnosis and prevalence from Cuyahoga County, Ohio. Sarcoidosis Vasc Diffuse Lung Dis 1998; 15 (01) 44-51
• 19 Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL. Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clin Proc 2016; 91 (02) 183-188
• 20 Dubrey S, Shah S, Hardman T, Sharma R. Sarcoidosis: the links between epidemiology and aetiology. Postgrad Med J 2014; 90 (1068): 582-589
• 21 Henke CE, Henke G, Elveback LR, Beard CM, Ballard DJ, Kurland LT. The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival. Am J Epidemiol 1986; 123 (05) 840-845
• 22 English III JC, Patel PJ, Greer KE. Sarcoidosis. J Am Acad Dermatol 2001; 44 (05) 725-743 , quiz 744–746
• 23 Rybicki BA, Major M, Popovich Jr J, Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol 1997; 145 (03) 234-241
• 24 Hillerdal G, Nöu E, Osterman K, Schmekel B. Sarcoidosis: epidemiology and prognosis: a 15-year European study. Am Rev Respir Dis 1984; 130 (01) 29-32
• 25 Lazarus A. Sarcoidosis: epidemiology, etiology, pathogenesis, and genetics. Dis Mon 2009; 55 (11) 649-660
• 26 Kahi CJ, Saxena R, Temkit M. , et al. Hepatobiliary disease in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2006; 23 (02) 117-123
• 27 Mirsaeidi M, Machado RF, Schraufnagel D, Sweiss NJ, Baughman RP. Racial difference in sarcoidosis mortality in the United States. Chest 2015; 147 (02) 438-449
• 28 Benatar SR. Sarcoidosis in South Africa. A comparative study in Whites, Blacks and Coloureds. S Afr Med J 1977; 52 (15) 602-606
• 29 Buck AA, Sartwell PE. Epidemiologic investigations of sarcoidosis. II. Skin sensitivity and environmental factors. Am J Hyg 1961; 74: 152-173
• 30 Gentry JT, Nitowsky HM, Michael Jr M. Studies on the epidemiology of sarcoidosis in the United States: the relationship to soil areas and to urban-rural residence. J Clin Invest 1955; 34 (12) 1839-1856
• 31 Rybicki BA, Iannuzzi MC. Epidemiology of sarcoidosis: recent advances and future prospects. Semin Respir Crit Care Med 2007; 28 (01) 22-35
• 32 Kajdasz DK, Lackland DT, Mohr LC, Judson MA. A current assessment of rurally linked exposures as potential risk factors for sarcoidosis. Ann Epidemiol 2001; 11 (02) 111-117
• 33 Newman LS, Rose CS, Bresnitz EA. , et al; ACCESS Research Group. A case control etiologic study of sarcoidosis: environmental and occupational risk factors. Am J Respir Crit Care Med 2004; 170 (12) 1324-1330
• 34 Peros-Golubicić T, Ljubić S. Cigarette smoking and sarcoidosis. Acta Med Croatica 1995; 49 (4-5): 187-193
• 35 Douglas JG, Middleton WG, Gaddie J. , et al. Sarcoidosis: a disorder commoner in non-smokers?. Thorax 1986; 41 (10) 787-791
• 36 Gupta D, Singh AD, Agarwal R, Aggarwal AN, Joshi K, Jindal SK. Is tobacco smoking protective for sarcoidosis? A case-control study from North India. Sarcoidosis Vasc Diffuse Lung Dis 2010; 27 (01) 19-26
• 37 Harf RA, Ethevenaux C, Gleize J, Perrin-Fayolle M, Guerin JC, Ollagnier C. Reduced prevalence of smokers in sarcoidosis: results of a case-control study. Ann N Y Acad Sci 1986; 465: 625-631
• 38 Judson MA. Hepatic, splenic, and gastrointestinal involvement with sarcoidosis. Semin Respir Crit Care Med 2002; 23 (06) 529-541
• 39 Ricker W, Clark M. Sarcoidosis: a clinicopathologic review of three hundred cases, including twenty-two autopsies. Am J Clin Pathol 1949; 19: 725-749
• 40 Iwai K, Oka H. Sarcoidosis: report of ten autopsy cases in Japan. Am Rev Respir Dis 1964; 90: 612-622
• 41 Hercules HD, Bethlem NM. Value of liver biopsy in sarcoidosis. Arch Pathol Lab Med 1984; 108 (10) 831-834
• 42 Bilir M, Mert A, Ozaras R. , et al. Hepatic sarcoidosis: clinicopathologic features in thirty-seven patients. J Clin Gastroenterol 2000; 31 (04) 337-338
• 43 Bihari C, Rastogi A, Kumar N, Rajesh S, Sarin SK. Hepatic Sarcoidosis: Clinico-pathological characterization of symptomatic cases. Acta Gastroenterol Belg 2015; 78 (03) 306-313
• 44 Israel HL, Goldstein RA. Hepatic granulomatosis and sarcoidosis. Ann Intern Med 1973; 79 (05) 669-678
• 45 Gaduputi V, Ippili R, Sakam S. , et al. Extrahepatic biliary obstruction: an unusual presentation of hepatic sarcoidosis. Clin Med Insights Gastroenterol 2015; 8: 19-22
• 46 Malhotra A, Naniwadekar A, Sood G. Hepatobiliary and pancreatic: cirrhosis secondary to hepatic sarcoidosis. J Gastroenterol Hepatol 2008; 23 (12) 1942
• 47 Korenromp IHE, Heijnen CJ, Vogels OJM, van den Bosch JMM, Grutters JC. Characterization of chronic fatigue in patients with sarcoidosis in clinical remission. Chest 2011; 140 (02) 441-447
• 48 Judson MA. Quality of life assessment in sarcoidosis. Clin Chest Med 2015; 36 (04) 739-750
• 49 Devaney K, Goodman ZD, Epstein MS, Zimmerman HJ, Ishak KG. Hepatic sarcoidosis: clinicopathologic features in 100 patients. Am J Surg Pathol 1993; 17 (12) 1272-1280
• 50 Kessler A, Mitchell DG, Israel HL, Goldberg BB. Hepatic and splenic sarcoidosis: ultrasound and MR imaging. Abdom Imaging 1993; 18 (02) 159-163
• 51 Kennedy PTF, Zakaria N, Modawi SB. , et al. Natural history of hepatic sarcoidosis and its response to treatment. Eur J Gastroenterol Hepatol 2006; 18 (07) 721-726
• 52 Blich M, Edoute Y. Clinical manifestations of sarcoid liver disease. J Gastroenterol Hepatol 2004; 19 (07) 732-737
• 53 Uthman IW, Bizri AR, Shabb NS, Khury MY, Khalifeh MJ. Peritoneal sarcoidosis: case report and review of the literature. Semin Arthritis Rheum 1999; 28 (05) 351-354
• 54 Nicolini A, Vita M, Lanata S. Peritoneal sarcoidosis: an unusual presentation and a brief review of the literature. Monaldi Arch Chest Dis 2011; 75 (02) 132-134
• 55 Chubineh S, Katona K. A rare case of peritoneal sarcoidosis in a 36-year-old construction worker. Case Rep Gastroenterol 2008; 2 (03) 369-372
• 56 Lubner MG, Pickhardt PJ. Peritoneal sarcoidosis: the role of imaging in diagnosis. Gastroenterol Hepatol (N Y) 2009; 5 (12) 861-863
• 57 Mannam P, Boselli JM, Schulman ES. Successful treatment of chylous ascites secondary to sarcoidosis with methotrexate. Hosp Pract (1995) 2009; 37 (01) 144-146
• 58 Provenza JM, Bacon BR. Chylous ascites due to sarcoidosis. Am J Gastroenterol 1991; 86 (01) 92-95
• 59 Moreno-Merlo F, Wanless IR, Shimamatsu K, Sherman M, Greig P, Chiasson D. The role of granulomatous phlebitis and thrombosis in the pathogenesis of cirrhosis and portal hypertension in sarcoidosis. Hepatology 1997; 26 (03) 554-560
• 60 Valla D, Pessegueiro-Miranda H, Degott C, Lebrec D, Rueff B, Benhamou JP. Hepatic sarcoidosis with portal hypertension: a report of seven cases with a review of the literature. Q J Med 1987; 63 (242) 531-544
• 61 Delfosse V, de Leval L, De Roover A. , et al. Budd-Chiari syndrome complicating hepatic sarcoidosis: definitive treatment by liver transplantation: a case report. Transplant Proc 2009; 41 (08) 3432-3434
• 62 Russi EW, Bansky G, Pfaltz M, Spinas G, Hammer B, Senning A. Budd-Chiari syndrome in sarcoidosis. Am J Gastroenterol 1986; 81 (01) 71-75
• 63 Ennaifer R, Bacha D, Romdhane H, Cheikh M, Nejma HB, BelHadj N. Budd-Chiari syndrome: an unusual presentation of multisystemic sarcoidosis. Clin Pract 2015; 5 (03) 768
• 64 Britt AR, Francis IR, Glazer GM, Ellis JH. Sarcoidosis: abdominal manifestations at CT. Radiology 1991; 178 (01) 91-94
• 65 Warshauer DM, Lee JKT. Imaging manifestations of abdominal sarcoidosis. AJR Am J Roentgenol 2004; 182 (01) 15-28
• 66 Warshauer DM, Molina PL, Hamman SM. , et al. Nodular sarcoidosis of the liver and spleen: analysis of 32 cases. Radiology 1995; 195 (03) 757-762
• 67 Kataria YP, Whitcomb ME. Splenomegaly in sarcoidosis. Arch Intern Med 1980; 140 (01) 35-37
• 68 Modaresi Esfeh J, Culver D, Plesec T, John B. Clinical presentation and protocol for management of hepatic sarcoidosis. Expert Rev Gastroenterol Hepatol 2015; 9 (03) 349-358
• 69 Pereira-Lima J, Schaffner F. Chronic cholestasis in hepatic sarcoidosis with clinical features resembling primary biliary cirrhosis: report of two cases. Am J Med 1987; 83 (01) 144-148
• 70 Rudzki C, Ishak KG, Zimmerman HJ. Chronic intrahepatic cholestasis of sarcoidosis. Am J Med 1975; 59 (03) 373-387
• 71 Amarapurkar DN, Patel ND, Amarapurkar AD. Hepatic sarcoidosis. Indian J Gastroenterol 2003; 22 (03) 98-100
• 72 Ferguson RH, Paris J. Sarcoidosis; study of twenty-nine cases, with a review of splenic, hepatic, mucous-membrane; retinal, and joint manifestations. AMA Arch Intern Med 1958; 101 (06) 1065-1084
• 73 Klatskin G, Yesner R. Hepatic manifestations of sarcoidosis and other granulomatous diseases; a study based on histological examination of tissue obtained by needle biopsy of the liver. Yale J Biol Med 1950; 23 (03) 207-248
• 74 Fetzer DT, Rees MA, Dasyam AK, Tublin ME. Hepatic sarcoidosis in patients presenting with liver dysfunction: imaging appearance, pathological correlation and disease evolution. Eur Radiol 2016; 26 (09) 3129-3137
• 75 Arai T, Akita S, Sakon M. , et al. Hepatocellular carcinoma associated with sarcoidosis. Int J Surg Case Rep 2014; 5 (08) 562-565
• 76 Cremers J, Drent M, Driessen A. , et al. Liver-test abnormalities in sarcoidosis. Eur J Gastroenterol Hepatol 2012; 24 (01) 17-24
• 77 Gezer NS, Başara I, Altay C. , et al. Abdominal sarcoidosis: cross-sectional imaging findings. Diagn Interv Radiol 2015; 21 (02) 111-117
• 78 Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW. Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?. Gastroenterology 1985; 89 (01) 186-191
• 79 Di Lelio A, Cestari C, Lomazzi A, Beretta L. Cirrhosis: diagnosis with sonographic study of the liver surface. Radiology 1989; 172 (02) 389-392
• 80 Hoeffel C, Bokemeyer C, Hoeffel JC, Gaucher H, Galanski M, Fornes P. CT hepatic and splenic appearances with sarcoidosis. Eur J Radiol 1996; 23 (02) 94-96
• 81 Calandriello L, Walsh SLF. Imaging for sarcoidosis. Semin Respir Crit Care Med 2017; 38 (04) 417-436
• 82 Kataoka M, Nakata Y, Hiramatsu J. , et al. Hepatic and splenic sarcoidosis evaluated by multiple imaging modalities. Intern Med 1998; 37 (05) 449-453
• 83 Scott GC, Berman JM, Higgins Jr JL. CT patterns of nodular hepatic and splenic sarcoidosis: a review of the literature. J Comput Assist Tomogr 1997; 21 (03) 369-372
• 84 Ohtomo K, Baron RL, Dodd III GD. , et al. Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT. Radiology 1993; 188 (01) 31-35
• 85 Taşbakan MI, Erdem HA, Pullukçu H. , et al. Isolated hepatic sarcoidosis mimicking liver microabscesses: a case report. Ir J Med Sci 2014; 183 (03) 503-505
• 86 Köklü H, Armağan B, Karadağ Ö. , et al. Multiple liver masses mimicking metastatic liver disease in an elderly patient. Turk J Gastroenterol 2018; 29 (01) 117-120
• 87 Warshauer DM, Semelka RC, Ascher SM. Nodular sarcoidosis of the liver and spleen: appearance on MR images. J Magn Reson Imaging 1994; 4 (04) 553-557
• 88 Karaosmanoğlu AD, Onur MR, Saini S, Taberi A, Karcaaltincaba M. Imaging of hepatobiliary involvement in sarcoidosis. Abdom Imaging 2015; 40 (08) 3330-3337
• 89 Lagana SM, Moreira RK, Lefkowitch JH. Hepatic granulomas: pathogenesis and differential diagnosis. Clin Liver Dis 2010; 14 (04) 605-617
• 90 Lamps LW. Hepatic granulomas: A review with emphasis on infectious causes. Arch Pathol Lab Med 2015; 139 (07) 867-875
• 91 Yeboah J, Afkhami M, Lee C, Sharma OP. Necrotizing sarcoid granulomatosis. Curr Opin Pulm Med 2012; 18 (05) 493-498
• 92 Rosen Y. Four decades of necrotizing sarcoid granulomatosis: what do we know now?. Arch Pathol Lab Med 2015; 139 (02) 252-262
• 93 Coash M, Forouhar F, Wu CH, Wu GY. Granulomatous liver diseases: a review. J Formos Med Assoc 2012; 111 (01) 3-13
• 94 You Z, Wang Q, Bian Z. , et al. The immunopathology of liver granulomas in primary biliary cirrhosis. J Autoimmun 2012; 39 (03) 216-221
• 95 Lewis J. Histopathology of granulomatous liver disease. Clin Liver Dis 2018; 11: 77-80
• 96 Sakamoto N, Ishimatsu Y, Kakugawa T. , et al. Sarcoidosis in a patient with systemic sclerosis and primary biliary cirrhosis. Intern Med 2010; 49 (15) 1609-1611
• 97 Alempijević T, Sokić-Milutinović A, Toncev L. , et al. Primary biliary cirrhosis and hepatic sarcoidosis: a case report. Vojnosanit Pregl 2014; 71 (01) 83-86
• 98 Heinle R, Chang C. Diagnostic criteria for sarcoidosis. Autoimmun Rev 2014; 13 (4-5): 383-387
• 99 Rose AS, Tielker MA, Knox KS. Hepatic, ocular, and cutaneous sarcoidosis. Clin Chest Med 2008; 29 (03) 509-524 , ix
• 100 Husic-Selimovic A, Sofic A, Huskic J, Bulja D. Effect of antiviral therapy on serum activity of angiotensin converting enzyme in patients with chronic hepatitis C. Med Arh 2016; 70 (02) 92-96
• 101 Tay A, Albayrak F, Ozmen S, Albayrak A, Ozden K. Is serum angiotensin-converting enzyme level useful for determining necroinflammatory activity in chronic hepatitis B infection?. Genet Test Mol Biomarkers 2017; 21 (02) 102-107
• 102 Jovicić I, Popović DDj, Toncev L. , et al. Isolated hepatic sarcoidosis. Vojnosanit Pregl 2014; 71 (04) 399-403
• 103 Gul W, Abbass K, Markert RJ, Akram S. Case of isolated hepatic sarcoidosis. Eur Rev Med Pharmacol Sci 2011; 15 (01) 107-108
• 104 Paramothayan S, Jones PW. Corticosteroid therapy in pulmonary sarcoidosis: a systematic review. JAMA 2002; 287 (10) 1301-1307
• 105 Moller DR. Treatment of sarcoidosis: from a basic science point of view. J Intern Med 2003; 253 (01) 31-40
• 106 Mueller S, Boehme MW, Hofmann WJ, Stremmel W. Extrapulmonary sarcoidosis primarily diagnosed in the liver. Scand J Gastroenterol 2000; 35 (09) 1003-1008
• 107 Nawfal G, Budin C, Bouvier R, Lachaux A. Elevated aminotransaminases as the first manifestation of sarcoidosis. Case Rep Med 2009; 2009: 193785
• 108 Dulai PS, Rothstein RI. Disseminated sarcoidosis presenting as granulomatous gastritis: a clinical review of the gastrointestinal and hepatic manifestations of sarcoidosis. J Clin Gastroenterol 2012; 46 (05) 367-374
• 109 Kelley Jr ML, McHARDY RJ. An unusual case of fatal hepatic sarcoidosis. Am J Med 1955; 18 (05) 842-850
• 110 Mosea H, Gotto J, Khan Z. Diagnostic and therapeutic challenges of hepatic sarcoidosis. BMJ Case Rep 2011; . [epub ahead of print]
• 111 Tan CB, Rashid S, Rajan D, Gebre W, Mustacchia P. Hepatic sarcoidosis presenting as portal hypertension and liver cirrhosis: case report and review of the literature. Case Rep Gastroenterol 2012; 6 (01) 183-189
• 112 Oketani M, Tsubouchi H, Hori T. , et al. Sarcoidosis with tumorous hepatic and bone lesions mimicking disseminated malignancy: a case report. Gastroenterol Jpn 1992; 27 (03) 414-417
• 113 Maddrey WC, Johns CJ, Boitnott JK, Iber FL. Sarcoidosis and chronic hepatic disease: a clinical and pathologic study of 20 patients. Medicine (Baltimore) 1970; 49 (05) 375-395
• 114 Judson MA. Sarcoidosis: clinical presentation, diagnosis, and approach to treatment. Am J Med Sci 2008; 335 (01) 26-33
• 115 Ulbricht KU, Stoll M, Bierwirth J, Witte T, Schmidt RE. Successful tumor necrosis factor alpha blockade treatment in therapy-resistant sarcoidosis. Arthritis Rheum 2003; 48 (12) 3542-3543
• 116 Ayyala US, Padilla ML. Diagnosis and treatment of hepatic sarcoidosis. Curr Treat Options Gastroenterol 2006; 9 (06) 475-483
• 117 Buchman AL. Side effects of corticosteroid therapy. J Clin Gastroenterol 2001; 33 (04) 289-294
• 118 Kaplan MM, Gershwin ME. Primary biliary cirrhosis. N Engl J Med 2005; 353 (12) 1261-1273
• 119 Bakker GJ, Haan YC, Maillette de Buy Wenniger LJ, Beuers U. Sarcoidosis of the liver: to treat or not to treat?. Neth J Med 2012; 70 (08) 349-356
• 120 Bécheur H, Dall'osto H, Chatellier G. , et al. Effect of ursodeoxycholic acid on chronic intrahepatic cholestasis due to sarcoidosis. Dig Dis Sci 1997; 42 (04) 789-791
• 121 Alenezi B, Lamoureux E, Alpert L, Szilagyi A. Effect of ursodeoxycholic acid on granulomatous liver disease due to sarcoidosis. Dig Dis Sci 2005; 50 (01) 196-200
• 122 Baratta L, Cascino A, Delfino M. , et al. Ursodeoxycholic acid treatment in abdominal sarcoidosis. Dig Dis Sci 2000; 45 (08) 1559-1562
• 123 Poupon R. Ursodeoxycholic acid and bile-acid mimetics as therapeutic agents for cholestatic liver diseases: an overview of their mechanisms of action. Clin Res Hepatol Gastroenterol 2012; 36 (Suppl. 01) S3-S12
• 124 Kumar D, Tandon RK. Use of ursodeoxycholic acid in liver diseases. J Gastroenterol Hepatol 2001; 16 (01) 3-14
• 125 Cremers JP, Drent M, Baughman RP, Wijnen PA, Koek GH. Therapeutic approach of hepatic sarcoidosis. Curr Opin Pulm Med 2012; 18 (05) 472-482
• 126 Tian H, Cronstein BN. Understanding the mechanisms of action of methotrexate: implications for the treatment of rheumatoid arthritis. Bull NYU Hosp Jt Dis 2007; 65 (03) 168-173
• 127 Baughman RP, Koehler A, Bejarano PA, Lower EE, Weber Jr FL. Role of liver function tests in detecting methotrexate-induced liver damage in sarcoidosis. Arch Intern Med 2003; 163 (05) 615-620
• 128 Baughman RP, Winget DB, Lower EE. Methotrexate is steroid sparing in acute sarcoidosis: results of a double blind, randomized trial. Sarcoidosis Vasc Diffuse Lung Dis 2000; 17 (01) 60-66
• 129 Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. Am J Med Sci 1990; 299 (03) 153-157
• 130 Cara CJ, Pena AS, Sans M. , et al. Reviewing the mechanism of action of thiopurine drugs: towards a new paradigm in clinical practice. Med Sci Monit 2004; 10 (11) RA247-RA254
• 131 Baughman RP, Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18 (01) 70-74
• 132 Baughman RP, Drent M, Kavuru M. , et al; Sarcoidosis Investigators. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006; 174 (07) 795-802
• 133 Sebode M, Weidemann S, Wehmeyer M, Lohse AW, Schramm C. Anti-TNF-α for necrotizing sarcoid granulomatosis of the liver. Hepatology 2017; 65 (04) 1410-1412
• 134 Russell E, Luk F, Manocha S, Ho T, O'Connor C, Hussain H. Long term follow-up of infliximab efficacy in pulmonary and extra-pulmonary sarcoidosis refractory to conventional therapy. Semin Arthritis Rheum 2013; 43 (01) 119-124
• 135 Judson MA, Baughman RP, Costabel U. , et al; Centocor T48 Sarcoidosis Investigators. Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir J 2008; 31 (06) 1189-1196
• 136 Keane J. TNF-blocking agents and tuberculosis: new drugs illuminate an old topic. Rheumatology (Oxford) 2005; 44 (06) 714-720
• 137 Deepak P, Sifuentes H, Sherid M, Stobaugh D, Sadozai Y, Ehrenpreis ED. T-cell non-Hodgkin's lymphomas reported to the FDA AERS with tumor necrosis factor-alpha (TNF-α) inhibitors: results of the REFURBISH study. Am J Gastroenterol 2013; 108 (01) 99-105
• 138 Denys BG, Bogaerts Y, Coenegrachts KL, De Vriese AS. Steroid-resistant sarcoidosis: is antagonism of TNF-α the answer?. Clin Sci (Lond) 2007; 112 (05) 281-289
• 139 Boots AW, Drent M, de Boer VC, Bast A, Haenen GR. Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis. Clin Nutr 2011; 30 (04) 506-512
• 140 Fidler HM, Hadziyannis SJ, Dhillon AP, Sherlock S, Burroughs AK. Recurrent hepatic sarcoidosis following liver transplantation. Transplant Proc 1997; 29 (05) 2509-2510
• 141 Vanatta JM, Modanlou K, Dean AG. , et al. Outcomes of orthotopic liver transplantation for hepatic sarcoidosis: an analysis of the United Network for Organ Sharing/Organ Procurement and Transplantation Network data files for a comparative study with cholestatic liver diseases. Liver Transpl 2011; 17: 1027-1034
• 142 Lipson EJ, Fiel MI, Florman SS, Korenblat KM. Patient and graft outcomes following liver transplantation for sarcoidosis. Clin Transplant 2005; 19 (04) 487-491
• 143 Casavilla FA, Gordon R, Wright HI, Gavaler JS, Starzl TE, Van Thiel DH. Clinical course after liver transplantation in patients with sarcoidosis. Ann Intern Med 1993; 118 (11) 865-866
• 144 Cengiz C, Rodriguez-Davalos M, deBoccardo G. , et al. Recurrent hepatic sarcoidosis post-liver transplantation manifesting with severe hypercalcemia: a case report and review of the literature. Liver Transpl 2005; 11 (12) 1611-1614
• 145 MacArthur KL, Forouhar F, Wu GYH. Intra-abdominal complications of sarcoidosis. J Formos Med Assoc 2010; 109 (07) 484-492
• 146 Tekeste H, Latour F, Levitt RE. Portal hypertension complicating sarcoid liver disease: case report and review of the literature. Am J Gastroenterol 1984; 79 (05) 389-396
• 147 Gupta S, Faughnan ME, Prud'homme GJ, Hwang DM, Munoz DG, Kopplin P. Sarcoidosis complicated by cirrhosis and hepatopulmonary syndrome. Can Respir J 2008; 15 (03) 124-126
• 148 Siltzbach LE. Sarcoidosis: clinical features and management. Med Clin North Am 1967; 51 (02) 483-502
• 149 Saleh S, Ghodsian S, Yakimova V, Henderson J, Sharma OP. Effectiveness of infliximab in treating selected patients with sarcoidosis. Respir Med 2006; 100 (11) 2053-2059
• 150 Doty JD, Mazur JE, Judson MA. Treatment of sarcoidosis with infliximab. Chest 2005; 127 (03) 1064-1071