PDF(Pubmed)
Abstract：
In certain cases, it is difficult to distinguish hepatic sarcoidosis from malignant lymphoma or drug-induced liver injury and to select the proper treatment for this condition. The present study describes the case of a female patient in her 30s who was referred to the hospital due to fever, arthralgia, myalgia and abnormal liver function test results for 4 months. A laboratory examination revealed elevated levels of serum angiotensin-converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R), as well as an increase in serum hepatic and biliary tract enzymes. Gallium scintigraphy revealed a marked uptake in the liver, as well as an uptake in the mediastinal, inguinal and external iliac lymph nodes. Magnetic resonance imaging revealed extensive hepatosplenomegaly with multiple non-enhancing splenic nodules. Hepatic sarcoidosis was diagnosed by a liver biopsy as non-caseating hepatic granulomas, and multinucleated giant cells were observed. The patient responded to treatment with 20 mg prednisolone daily, and exhibited an improvement in her symptoms. An improvement was also observed in her serum levels of ACE, sIL-2R, and serum hepatic and biliary tract enzymes; decreased gallium uptake in the liver was also observed. On the whole, the present case report reconfirms that liver biopsy is a useful diagnostic tool for hepatic sarcoidosis.
摘要：
在某些情况下,很难区分肝结节病与恶性淋巴瘤或药物性肝损伤，并选择合适的治疗方法。本研究描述了一名30多岁的女性患者因发烧而被转诊到医院的情况，关节痛,肌痛和肝功能异常检查结果为4个月。实验室检查显示血清血管紧张素转换酶（ACE）和可溶性白介素2受体（sIL-2R）水平升高，以及血清肝脏和胆道酶的增加。镓闪烁显像显示肝脏有明显的摄取，以及纵隔的摄取，腹股沟和髂外淋巴结。磁共振成像显示广泛的肝脾肿大伴多个非增强脾结节。肝结节病通过肝活检诊断为非干酪性肝肉芽肿，观察到多核巨细胞。患者对每天20毫克泼尼松龙的治疗有反应，症状有所改善.她的血清ACE水平也有改善，sIL-2R,和血清肝和胆道酶；还观察到肝脏中镓的摄取减少。总的来说,本病例报告再次证实，肝活检是肝结节病的有用诊断工具。
