{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:15:48Z","timestamp":1756383348516,"version":"3.44.0"},"reference-count":43,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,11,12]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>Sarcoidosis is a multisystem inflammatory disorder associated with non-caseating granulomas in affected organs, most commonly the lungs. Involvement of extrapulmonary organs is common, but lack of pulmonary involvement is rare and is called non-pulmonary sarcoidosis (NPS). Like pulmonary sarcoidosis, a definitive diagnostic test for NPS does not exist. Instead, the diagnosis of sarcoidosis requires the following elements: clinical and radiographic manifestations of sarcoidosis, histopathological detection of non-caseating granulomas and the exclusion of other diseases that may present similarly. Because of the experience with corticosteroids in pulmonary sarcoidosis, they are generally considered first-line therapy for NPS too. Ursodeoxycholic acid can be used to reduce cholestasis in NPS, but is inferior to corticosteroids in reducing inflammation. We hereby present a case that is particularly notable for its rare presentation of NPS as a granulomatous hepatitis with cholestatic liver function tests.<\/jats:p>","DOI":"10.1136\/bcr-2019-232618","type":"journal-article","created":{"date-parts":[[2019,12,5]],"date-time":"2019-12-05T04:55:22Z","timestamp":1575521722000},"page":"e232618","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Extrapulmonary sarcoidosis primarily presenting as cholestatic liver disease"],"prefix":"10.1136","volume":"12","author":[{"given":"Pieter","family":"De Mulder","sequence":"first","affiliation":[{"name":"Internal Medicine, Ghent University, Gent, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bert","family":"Maertens","sequence":"additional","affiliation":[{"name":"Internal Medicine, Ghent University, Gent, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Hoorens","sequence":"additional","affiliation":[{"name":"Anatomopathology, Ghent University, Gent, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"An","family":"Vonck","sequence":"additional","affiliation":[{"name":"Nephrology, Algemeen Ziekenhuis Sint Blasius campus Dendermonde, Dendermonde, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,12,4]]},"reference":[{"key":"2025082701093617000_12.12.e232618.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra071714"},{"key":"2025082701093617000_12.12.e232618.2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.10.2104046"},{"key":"2025082701093617000_12.12.e232618.3","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.chest.2018.02.003","article-title":"Clinical features of extrapulmonary sarcoidosis without lung involvement","volume":"154","author":"James","year":"2018","journal-title":"Chest"},{"key":"2025082701093617000_12.12.e232618.4","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s00408-017-0015-4","article-title":"Sarcoidosis in Israel: clinical outcome status, organ involvement, and long-term follow-up","volume":"195","author":"Markevitz","year":"2017","journal-title":"Lung"},{"key":"2025082701093617000_12.12.e232618.5","first-page":"119","article-title":"The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. 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