Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 4180    

   Table of Contents      
CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 186-187

Sarcoidosis mimicking as liver & splenic abscess


Department of Clinical Immunology & Rheumatology, Amrita Institute of Medical Sciences, Kochi 682 041, Kerala, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Arun Tiwari
Department of Clinical Immunology & Rheumatology, Amrita Institute of Medical Sciences, Kochi 682 041, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2288_19

Rights and Permissions

How to cite this article:
Tiwari A, Mithun C B. Sarcoidosis mimicking as liver & splenic abscess. Indian J Med Res 2020;152, Suppl S1:186-7

How to cite this URL:
Tiwari A, Mithun C B. Sarcoidosis mimicking as liver & splenic abscess. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:186-7. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/186/316812

Patient's consent obtained to publish clinical information and images


A 56 yr old man presented to the department of Clinical Immunology and Rheumatology, Amrita Institute of Medical Sciences, Kochi, India, in June 2019, with recurrent pyrexial illness, papulopustular skin lesions [Figure 1], constitutional symptoms and raised inflammatory markers for the last three years. Computed tomography of the abdomen revealed multiple hepatic and splenic lesions, suggestive of abscesses [Figure 2]. There was no growth documented on cultures, and tuberculosis workup was also negative. Biopsies taken from skin, liver and bone marrow were inconclusive. However, his positron-emission tomography (PET)-magnetic resonance (MR) showed inflammatory uptakes in the liver, spleen and abdominal lymph nodes [Figure 3]. Based on the above clinical, biochemical and radiological findings, a diagnosis of granulomatous disease was considered and the patient was subjected to repeat skin biopsy which revealed granulomas [Figure 4]. He was diagnosed with sarcoidosis and started on steroids and azathioprine. He was in remission at six months of follow up.
Figure 1: Papulopustular skin lesions over trunk at the time of pyrexial illness.

Click here to view
Figure 2: Computed tomography abdomen image with liver showing multiple hypodense (marked with hollow arrows) lesion with subtle peripheral enhancement and splenomegaly.

Click here to view
Figure 3: Positron-emission tomography-magnetic resonance image showing FDG avid multiple mediastinal and intra-abdominal lymph nodes, FDG avid and non-avid T2 hyperintense lesions in the spleen (arrows noted A in image) and FDG non-avid T2 hyperintense lesions in the liver (arrows noted B in image).

Click here to view
Figure 4: Histopathology image: Skin biopsy, from papulopustular lesion over the upper back. Image showing ill-to-well-formed granulomas (hollow arrow) with giant cells, interstitial giant cells and histiocytes in the upper dermis (H and E, ×10).

Click here to view


Sarcoidosis has varied clinical manifestations, and in this case, it was a close mimic to liver, splenic abscess and skin pustulosis. Key points in this case that led to the diagnosis were multisystem involvement, abdominal lymph nodes uptake on PET, raised inflammatory markers and granulomas on skin biopsy.

Acknowledgment: Authors acknowledge Dr Malini Eapen, Department of Pathology, AIMS, Kochi, for carrying out the histopathological analysis of the skin biopsy and providing the respective image.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Article Figures

 Article Access Statistics
    Viewed162    
    Printed0    
    Emailed0    
    PDF Downloaded24    
    Comments [Add]    

Recommend this journal