Finger clubbing and cirrhosis in a sarcoidosis patient

Monaldi Arch Chest Dis. 2019 Oct 18;89(3). doi: 10.4081/monaldi.2019.1141.

Abstract

Sarcoidosis is a multisystem granulomatous inflammatory disorder frequently affecting the lungs, but also the liver, along with cirrhosis and portal hypertension occurring in less than 1% of the patients. A 56-year-old female presented with dyspnea, abdominal and leg swelling. Physical examination revealed finger clubbing, ascites and pretibial edema. Chest CT revealed diffuse micronodular opacities in both lungs without any enlarged thoracic lymph nodes. PFTs and DLCO/VA were moderately decreased. Transbronchial biopsy revealed non-caseified granulomas compatible with sarcoidosis. Serologic markers for infectious and autoimmune hepatitis were negative. Liver biopsy showed non-caseating granulomas, severe hepatitis and fibrosis. Stool, urinary analysis and antibodies for Schistosoma infection were negative. Final diagnosis was cirrhosis associated with stage III sarcoidosis. We report a case of sarcoidosis complicated by cirrhosis and portal hypertension with finger clubbing. Clinicians should bear in mind that cirrhosis, portal hypertension and clubbing may arise as the initial manifestations of sarcoidosis.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use
  • Ascites / diagnosis
  • Ascites / etiology
  • Diuretics / administration & dosage
  • Diuretics / therapeutic use
  • Female
  • Furosemide / administration & dosage
  • Furosemide / therapeutic use
  • Humans
  • Hypertension, Portal / diagnosis
  • Hypertension, Portal / etiology
  • Liver Cirrhosis / etiology*
  • Liver Cirrhosis / pathology
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / pathology
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Osteoarthropathy, Secondary Hypertrophic / diagnosis*
  • Sarcoidosis / complications*
  • Sarcoidosis / diagnostic imaging
  • Sarcoidosis / drug therapy
  • Sarcoidosis / pathology
  • Tomography, X-Ray Computed / methods

Substances

  • Anti-Inflammatory Agents
  • Diuretics
  • Furosemide
  • Methylprednisolone