Hepatic Sarcoidosis and Spondyloarthritis Overlap: Efficacy and Safety of TNF Inhibitors - A Case Report

Abstract

BACKGROUND: Sarcoidosis is a chronic, multisystemic inflammatory disease characterized by the formation of non-necrotizing granulomas. While rare, there have been reported cases of sarcoidosis coexisting with spondyloarthritis. This case report aimed to highlight the diagnostic and therapeutic challenges in such cases. CASE PRESENTATION: A 54-year-old woman presented with a 3-month history of abdominal pain, anorexia, and fatigue, along with a 10-year history of inflammatory low back pain and pygalgia. Physical examination revealed hepatosplenomegaly and a positive sacral thrust test. Inflammatory biomarkers were slightly elevated, and the patient tested positive for human leukocyte antigen B27 (HLA-B27). Radiographs indicated mediastinal enlargement and bilateral ankylosis of the sacroiliac joints. Computed tomography (CT) revealed mediastinal lymph nodes, hepatomegaly, and imaging findings consistent with portal hypertension. Bronchoalveolar lavage showed significant lymphocytosis, and the histopathological examination of mediastinal lymph nodes confirmed the presence of granulomas. Liver biopsy histopathology indicated signs of cirrhosis. The patient was diagnosed with sarcoidosis involving the mediastinum and liver associated with spondyloarthritis. Treatment with adalimumab was initiated, which resulted in good clinical and biological outcomes after six months of follow-up. CONCLUSION: The diagnosis of spondyloarthritis should be considered in patients with sarcoidosis who present with low back pain or pygalgia. The coexistence of spondyloarthritis and sarcoidosis, further complicated by hepatic cirrhosis and portal hypertension, presents significant therapeutic challenges. This case report suggests that adalimumab is an effective and safe treatment option for patients with spondyloarthritis and sarcoidosis associated with cirrhosis.