Abstract
Sarcoidosis is an idiopathic granulomatous disease most commonly involving the lungs;
however, isolated extrapulmonary manifestations such as hepatic sarcoidosis are rare
and diagnostically challenging. We describe a case of hepatic sarcoidosis in a 24-year-old
man who presented with a three-month history of low-grade fever and unintentional
weight loss. Clinical examination was unremarkable, and initial blood investigations
revealed elevated alkaline phosphatase, lactate dehydrogenase, inflammatory markers,
and serum ACE levels, with a negative work-up for tuberculosis and autoimmune diseases.
Chest imaging was normal. [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed diffuse hypermetabolic liver (hot liver) with reduced physiological
uptake in the myocardium and kidneys, consistent with a hepatic superscan pattern.
No significant pulmonary nodules or mediastinal/hilar nodal involvement was detected.
In view of the hepatic superscan, a liver biopsy was suggested, which revealed hepatic
sarcoidosis. The patient was diagnosed with ‘Hepatic sarcoidosis’ and responded well
to corticosteroid therapy. This case highlights the importance of [18F] FDG PET/CT in guiding diagnosis in cases of unexplained systemic symptoms. The
hepatic superscan appearance, typically associated with malignancy, can also be observed
in rare granulomatous diseases such as sarcoidosis, reinforcing the need for histopathological
confirmation. [18F] FDG PET/CT is also beneficial for a whole-body survey in detecting occult diseases
and guiding further investigations, such as targeted biopsies.
Keywords
[
18F]-FDG PET/CT - hepatic sarcoidosis - hepatic superscan - histopathology - infective
etiology - infiltrative disorders
