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June 23, 1978

The Budd-Chiari Syndrome in Sarcoidosis

Author Affiliations

Brooke Army Medical Center Fort Sam Houston, Tex

JAMA. 1978;239(25):2657-2658. doi:10.1001/jama.1978.03280520029009

To the Editor.—  Hepatic involvement by sarcoidosis is well known. The most common manifestation is a noncaseating granulomatous hepatitis.1 Associated findings may include chronic intrahepatic cholestasis, periportal fibrosis, and eventual development of a micronodular cirrhosis.1 To our knowledge, hepatic-vein thrombosis (Budd-Chiari syndrome) has not been encountered as a complication of sarcoidosis. We recently studied a patient with sarcoidosis in whom acute hepatic-vein thrombosis occurred in the absence of other underlying causes.

Report of a Case.—  A 19-year-old black man was admitted for evaluation of abdominal pain, weight loss, night sweats, and an abnormal chest roentgenogram. Systems review showed a history of sickle cell trait but no prior sickle cell crises or prior abdominal trauma. Physical findings included hepatomegaly, splenomegaly, and a maculopapular, hyperpigmented rash on the chest and legs. Chest roentgenograms showed bilateral hilar lymphadenopathy. Pertinent laboratory values included alkaline phosphatase, 315 IU; total bilirubin, 2.8 mg/dl; hematocrit,