COURSE OF ASYMPTOMATIC LIVER INVOLVEMENT IN SARCOIDOSIS - ROLE OF THERAPY IN SELECTED CASES

Aim: Although granulomatous involvement of the liver with functional a bnormalities is widely known, the course of these abnormalities is not clearly known. The study was designed to find out the incidence and c ourse of asymptomatic liver function abnormalities. Methods: From 1990 - 1995, during the five year period, 44 (35.2%) of 125 patients with sarcoidosis at LAC+USC Medical Center had liver involvement. Liver enz yme abnormalities aspartate aminotransferase (AST), alanine aminotrans ferase (ALT), and alkaline phosphatase (AP) were taken as criteria for liver involvement: 41 (93%) patients had elevated AP, 22 (50%) showed elevated ALT, and 24 (54.5%) had elevated AST. Results. 25 of 44 pati ents received treatment; 12 (48%) showed improvement in liver enzymes and 13 (52%) remained unchanged. Ten (7%) of 13 patients, who did not receive any treatment, also improved. During the same period at USC Un iversity Hospital 18 (25%) of 72 had liver involvement. Twelve patient s received treatment; 6 (50%) patients showed improvement in liver enz ymes. One of 3 patients, who did not receive treatment, improved. 5 (4 1%) developed complications due to steroids. Conclusion: Liver involve ment is common in African American patients with sarcoidosis. Social a nd economic status do not seem to influence the liver involvement. In men the age distribution has an early peak, The outcome of patients wh o receive treatment remains similar, as far as liver function is conce rned, suggesting that most of the patients with liver involvement unde rgo natural remission. Unless the patient has progressive liver dysfun ction, it is advisable to monitor liver enzymes periodically and obtai n liver biopsies only if clinically indicated. In patients who need tr eatment, it is reasonable to try options other than steroids in view o f severe corticosteroid related complications.