Aravinthan A, Gelson W, Limbu A, Brais R, Richardson P. Hepatic sarcoidosis complicating treatment-naive viral hepatitis. World J Hepatol 2012; 4(12): 402-405 [PMID: 23355920 DOI: 10.4254/wjh.v4.i12.402]
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Dr. Paul Richardson, MRCP (UK), Department of Hepatology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L7 8XP, United Kingdom. firstname.lastname@example.org
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Aloysious Aravinthan, William Gelson, Anita Limbu, Rebecca Brais, Paul Richardson
Aloysious Aravinthan, William Gelson, Anita Limbu, Department of Hepatology, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
Rebecca Brais, Department of Histopathology, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
Paul Richardson, Department of Hepatology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L7 8XP, United Kingdom
Author contributions: Aravinthan A and Richardson P designed the case series and wrote the paper; Gelson W and Limbu A assisted with collecting relevant data; and Brais R provided histological images.
Correspondence to: Dr. Paul Richardson, MRCP (UK), Department of Hepatology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L7 8XP, United Kingdom. email@example.com
Telephone: +44-7888-738137 Fax: +44-1223-216111
Received: September 15, 2011 Revised: March 5, 2012 Accepted: November 14, 2012 Published online: December 27, 2012
Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome. Co-existence of viral hepatitis and hepatic sarcoidosis is a rare, but recognised phenomenon. Obtaining a balance between immune suppression and anti-viral therapy may be problematic. Immunosuppression in the presence of viral hepatitis can lead to rapid deterioration of liver disease. Similarly, anti-viral therapy may exacerbate granulomatous hepatitis. Here we present two cases of viral hepatitis co-existing with sarcoidosis that illustrate successful management strategies. In one, hepatitis B replication was suppressed with oral anti-viral therapy before commencing prednisolone. In the second, remission of hepatic sarcoidosis was achieved with prednisolone, before treating hepatitis C and obtaining a sustained virological response with pegylated interferon and ribavirin therapy.