A case of hepatic sarcoidosis complicated by portal hypertension

We report a rare case of hepatic sarcoidosis complicated by portal hypertension. A 39-year-old male patient underwent laparoscopy, which was useful for accurate diagnosis. The initial symptom was hematemesis caused by rupture of esophageal varices 2 years ago. At that time, the chest CT scan showed bilateral hilar lymphadenopathy and small granular shadows in the both lung fields. Lymph node biopsy demonstrated noncaseating granuloma. Based on these findings, he was given a diagnosis of pulmonary sarcoidosis. Since no respiratory disturbance was observed, he was referred to our department for further investigation of portal hypertension. Liver surface images obtained by a laparoscopy showed many white nodules. Liver biopsy revealed noncaseating granuloma in portal areas. Thus, we speculated nodules of sarcoidosis caused portal hypertension. Because hepatic sarcoidosis progressed to liver cirrhosis,we administrated corticosteroid to reduce deisease activity. Currently, liver function tests have improved slightly and esophageal varices remained stable.