A case of hepatic and bone marrow sarcoidosis with progressive renal failure: diagnostic and therapeutic challenges

Main Article Content

Pierluigi Brugnaro
Francesca Cattelan
Erika Morelli
Andrea Petrucci
Alessandro Marocco
Sandro Panese
Pietro Maria Donisi
Giovanni Capitanio
Mauro Tollot


Sarcoidosis; Extra-pulmonary; Granulomatous diseases


Sarcoidosis is a systemic granulomatous disease, sometimes characterized by an extrapulmonary localization in 30 – 50% of cases. We describe a 60-year-old Italian man with an unexplained history of fatigue, ascitis and progressive renal function impairment. Diagnosis of hepatic and bone marrow sarcoidosis was established by histology, and fast improvement of renal function was obtained after starting  corticosteroid therapy. Atypical presentation and simultaneous involvement of liver, bone marrow and kidneys make diagnosis of extrapulmonary sarcoidosis still a diagnostic challenge. Delayed diagnosis could lead to serious organ damage like a progressive severe kidney failure.

Abstract 410 | PDF Downloads 376


1. Valeyre D, Prasse A, Nunes H, Uzunan Y, Brillet P-Y, and Müller-Quernheim Y. Sarcoidosis. Lancet 2014;383:1155-1167
2. Tana C, Tana M, Mezzetti A, and Schiavone C. Sarcoidosis: old certainties and new perspectives. It J Med 2012;6:186-194
3. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67:2089-2100.
4. Morgenthau AS, and Teirstein AS. Sarcoidosis of the upper and lower airways. Expert Rev Respir Med 2011;5(6):823—33.
5. Keijsers RG, and Grutters JC. In Which Patients with Sarcoidosis Is FDG PET/CT Indicated? J Clin Med 2020;9:890.
6. Keijsers RG, Grutters JC, Thomeer M, et al. Imaging the inflammatory activity of sarcoidosis: sensitivity and inter observer agreement of (67)Ga-imaging and (18)F-FDG PET. Q J Nucl Med Mol Imaging 2011;55(1):66—71.
7. Nunes H, Brillet PY, Valeyre D, Brauner MW, Wells AU. Imaging in sarcoidosis. Semin Respir Crit Care Med 2007;28(1):102—20.).
8. Cremers J, Drent M, Driessen A, et al. Liver-test abnormalities in sarcoidosis. Eur J Gastroenterol Hepatol 2012;24:17-24
9. Ebert EC, Kierson M, and Hagspiel KD. Gastroeintestinal and hepatic manifestations of sarcoidosis. Am J Gastroenterol 2008;103;3184-3192.
10. Tadros M, Forouhar F, and Wu YG. Hepatic sarcoidosis. J Clin Translat Hepatol 2’13;1:87-93.
11. Brackers de Hugo L, Ffrench M, Broussolle C, and Sève P. Granulomatous lesions in bone marrow: Clinicopathologic findings and significance in a study of 48 cases. Eur J Int Med 2013;24:468-473.
12. Pena-Garcia JI, Shaikh S, Barakoti B, Papageorgiou C, and Lacasse A. Bone marrow involvement in sarcoidosis: an elusive extrapulmonary manifestation. J Community Hosp Int Med Perspectives 2019;9:150-154.
13. Longcope WT, and Freiman DG. A study of sarcoidosis; based on a combined investigation of 160 cases including 30 autopsies from The Johns Hopkins Hospital and Massachusetts General Hospital. Medicine 1952;31:1-132.
14. Mahévas M, Lescure FX, Boffa J-J, et al. Renal sarcoidosis: clinical, laboratory, and histologic presentation and outcome in 47 patients. Medicine 2009;88:98-106.
15. Bear RA, Handelsman S, Lang A, et al. Clinical and pathological features of six cases of sarcoidosis presenting with renal failure. Can Med Assoc J 1979;121:1367-1371.