Case Report | | Peer-Reviewed

Anicteric Cholestasis Syndrome with Pruritus Revealing Systemic Sarcoidosis

Received: 14 April 2024    Accepted: 7 May 2024    Published: 24 May 2024
Views:       Downloads:
Abstract

Introduction: Sarcoidosis is a systemic granulomatosis of unknown aetiology characterised by the formation of non-caseating granulomas in organs. Hepatic involvement can be difficult to diagnose. Material and method: We report the case of a 30-year-old female patient with a long history of intractable pruritus revealing systemic sarcoidosis. Case report: A 30-year-old female patient presented with a persistent pruritus without jaundice or fever. Examination revealed tender hepatomegaly and scratch lesions. Laboratory tests revealed elevated liver enzymes with cholestasis, and serum protein electrophoresis showed an inflammatory profile. The different viral hepatitis tests were non-contributory. Alpha fetoprotein was normal. Abdominal ultrasound and CT scans revealed a heteronodular hepatomegaly. The first liver biopsy was consistent with autoimmune hepatitis lesions. The disease improved with general corticosteroid therapy and azathioprine. Two years later, with the persistence of the pruritus, blood calcium levels and angiotensin-converting enzyme tests were found to be elevated. A new liver biopsy showed epitheliogigantocellular granulomas without caseous necrosis. A thoracic CT scan revealed mediastinal adenopathy. This suggested systemic sarcoidosis. The patient progressed well clinically and radiologically on general corticosteroids with adjuvant therapy and azathioprine. Conclusion: Sarcoidosis is a systemic disease that can affect most tissues and organs. Hepatic involvement is frequent and more often difficult to diagnose.

Published in American Journal of Internal Medicine (Volume 12, Issue 2)
DOI 10.11648/j.ajim.20241202.11
Page(s) 16-20
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pruritus, Sarcoidosis, Hepatic

References
[1] Valeyre D et al. Sarcoïdose. Lancet. 2014; 383(9923): 1155-1167.
[2] Ketari J. Maamouri N. Ben Dhaou D. et al. Hepatic involvement in sarcoidosis: study of seven cases. Rev med int. 2010; 31(1): 12-16.
[3] Elloumi H. Marzouk S. Tahri N. Bahloul Z. Sarcoidosis and liver disease: a series of 25 patients. Rev med int. 2012; 33(11): 607-614.
[4] Geri G. Saadoun D. Cacoub P. Hepatic manifestations of systemic diseases. Rev med int. 2011; 32: 486–493.
[5] Oumnia N. Lahcene M. Tebaibia A. et al. Hepatic sarcoidosis: 20 observations. Multicentre study in Algeria. In JFHOD. 2023. P135.
[6] Garnier C. Pugnet G. Moulis G. et al. A rare cause of pruritus in severe sarcoidosis. Rev Med Int. 2014; 35(S1): 149.
[7] Kheder M. Saïd F. Hamzaoui A. et al. Hepatosplenic involvement in sarcoidosis: a case report of 31 patients. Rev med int. 2018; 39(01): A195.
[8] Bouchra I. Kabbaj N. Rimani M. et al. Cytolysis and anicteric cholestasis revealing pulmonary sarcoidosis (a case report). Hegel. 2013; 1(1): 33-38.
[9] Lyko C. Bart PA. Pruvot E. et al. extrapulmonary sarcoidosis, a little-known entityRev Med suisse. 2010; 6: 2056-2060.
[10] Frappard T. LePendu C. Meignin V. et al. Ultrasound-guided splenic biopsy: an efficient diagnostic tool in sarcoidosis? Rev med int. 2019. 40(9): 609-612.
[11] Rochat TS. Janssens JP. Soccal PM. Et al. Update on the treatment of sarcoidosis. Rev Med Suisse. 2016; 539(2): 1966–1971.
[12] Sah BP. Goyal S. Iannuzzi MC. Novel pharmacotherapy of sarcoidosis. Pharmacol Ther. 2016; 157: 1–9.
[13] Ndili Obi O. Saketkoo LA. Russel AM. Baughman RP. Sarcoidosis: updates on therapeutic drug trials and new treatment approaches. Front Med (Lausanne). 2022; 9: 1-27.
Cite This Article
  • APA Style

    Mansour, D. B., Abdou, F. F., Baba, N. M., Adama, W., Mamadou, D., et al. (2024). Anicteric Cholestasis Syndrome with Pruritus Revealing Systemic Sarcoidosis. American Journal of Internal Medicine, 12(2), 16-20. https://doi.org/10.11648/j.ajim.20241202.11

    Copy | Download

    ACS Style

    Mansour, D. B.; Abdou, F. F.; Baba, N. M.; Adama, W.; Mamadou, D., et al. Anicteric Cholestasis Syndrome with Pruritus Revealing Systemic Sarcoidosis. Am. J. Intern. Med. 2024, 12(2), 16-20. doi: 10.11648/j.ajim.20241202.11

    Copy | Download

    AMA Style

    Mansour DB, Abdou FF, Baba NM, Adama W, Mamadou D, et al. Anicteric Cholestasis Syndrome with Pruritus Revealing Systemic Sarcoidosis. Am J Intern Med. 2024;12(2):16-20. doi: 10.11648/j.ajim.20241202.11

    Copy | Download

  • @article{10.11648/j.ajim.20241202.11,
      author = {Diallo Bachir Mansour and Faye Fulgence Abdou and Nana Mamoudou Baba and Wade Adama and Diack Mamadou and Ndour Ndour Jean Noel Ndour and Mbaye Serigne Abdou Khadr and Ndiaye Yanidou and Berthé Adama and Touré Papa Souleymane and Diop Madoky Magatte and Ka Mamadou Mourtalla},
      title = {Anicteric Cholestasis Syndrome with Pruritus Revealing Systemic Sarcoidosis
    },
      journal = {American Journal of Internal Medicine},
      volume = {12},
      number = {2},
      pages = {16-20},
      doi = {10.11648/j.ajim.20241202.11},
      url = {https://doi.org/10.11648/j.ajim.20241202.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20241202.11},
      abstract = {Introduction: Sarcoidosis is a systemic granulomatosis of unknown aetiology characterised by the formation of non-caseating granulomas in organs. Hepatic involvement can be difficult to diagnose. Material and method: We report the case of a 30-year-old female patient with a long history of intractable pruritus revealing systemic sarcoidosis. Case report: A 30-year-old female patient presented with a persistent pruritus without jaundice or fever. Examination revealed tender hepatomegaly and scratch lesions. Laboratory tests revealed elevated liver enzymes with cholestasis, and serum protein electrophoresis showed an inflammatory profile. The different viral hepatitis tests were non-contributory. Alpha fetoprotein was normal. Abdominal ultrasound and CT scans revealed a heteronodular hepatomegaly. The first liver biopsy was consistent with autoimmune hepatitis lesions. The disease improved with general corticosteroid therapy and azathioprine. Two years later, with the persistence of the pruritus, blood calcium levels and angiotensin-converting enzyme tests were found to be elevated. A new liver biopsy showed epitheliogigantocellular granulomas without caseous necrosis. A thoracic CT scan revealed mediastinal adenopathy. This suggested systemic sarcoidosis. The patient progressed well clinically and radiologically on general corticosteroids with adjuvant therapy and azathioprine. Conclusion: Sarcoidosis is a systemic disease that can affect most tissues and organs. Hepatic involvement is frequent and more often difficult to diagnose.
    },
     year = {2024}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Anicteric Cholestasis Syndrome with Pruritus Revealing Systemic Sarcoidosis
    
    AU  - Diallo Bachir Mansour
    AU  - Faye Fulgence Abdou
    AU  - Nana Mamoudou Baba
    AU  - Wade Adama
    AU  - Diack Mamadou
    AU  - Ndour Ndour Jean Noel Ndour
    AU  - Mbaye Serigne Abdou Khadr
    AU  - Ndiaye Yanidou
    AU  - Berthé Adama
    AU  - Touré Papa Souleymane
    AU  - Diop Madoky Magatte
    AU  - Ka Mamadou Mourtalla
    Y1  - 2024/05/24
    PY  - 2024
    N1  - https://doi.org/10.11648/j.ajim.20241202.11
    DO  - 10.11648/j.ajim.20241202.11
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 16
    EP  - 20
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20241202.11
    AB  - Introduction: Sarcoidosis is a systemic granulomatosis of unknown aetiology characterised by the formation of non-caseating granulomas in organs. Hepatic involvement can be difficult to diagnose. Material and method: We report the case of a 30-year-old female patient with a long history of intractable pruritus revealing systemic sarcoidosis. Case report: A 30-year-old female patient presented with a persistent pruritus without jaundice or fever. Examination revealed tender hepatomegaly and scratch lesions. Laboratory tests revealed elevated liver enzymes with cholestasis, and serum protein electrophoresis showed an inflammatory profile. The different viral hepatitis tests were non-contributory. Alpha fetoprotein was normal. Abdominal ultrasound and CT scans revealed a heteronodular hepatomegaly. The first liver biopsy was consistent with autoimmune hepatitis lesions. The disease improved with general corticosteroid therapy and azathioprine. Two years later, with the persistence of the pruritus, blood calcium levels and angiotensin-converting enzyme tests were found to be elevated. A new liver biopsy showed epitheliogigantocellular granulomas without caseous necrosis. A thoracic CT scan revealed mediastinal adenopathy. This suggested systemic sarcoidosis. The patient progressed well clinically and radiologically on general corticosteroids with adjuvant therapy and azathioprine. Conclusion: Sarcoidosis is a systemic disease that can affect most tissues and organs. Hepatic involvement is frequent and more often difficult to diagnose.
    
    VL  - 12
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Department of Internal Medicine, Abdou Aziz Sy Hospital, Tivaouane, Senegal

  • School of Medicine, Alioune Diop University in Bambey, Bambey, Senegal

  • Department of Internal Medicine, Thies Regional Hospital, Thies, Senegal

  • Department of Internal Medicine, Abdou Aziz Sy Hospital, Tivaouane, Senegal

  • Department of Internal Medicine, Abdou Aziz Sy Hospital, Tivaouane, Senegal

  • Department of Internal Medicine, Abdou Aziz Sy Hospital, Tivaouane, Senegal

  • Department of Internal Medicine, Abdou Aziz Sy Hospital, Tivaouane, Senegal

  • Department of Internal Medicine, Thies Regional Hospital, Thies, Senegal

  • Department of Internal Medicine, Thies Regional Hospital, Thies, Senegal

  • Department of Internal Medicine, Abdou Aziz Sy Hospital, Tivaouane, Senegal

  • Department of Internal Medicine, Thies Regional Hospital, Thies, Senegal

  • School of Medicine, Iba Der Thiam University, Thies, Senegal

  • Sections