Author:
Santosa Anindita,Wong Chin Fong,Koh Li Wearn
Abstract
We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.
Reference85 articles.
1. Sarcoidosis: histopathological definition and clinical diagnosis.
2. Ministry of Health. Communicable diseases surveillance in Singapore 2013 annual report. Singapore: Ministry of Health.
3. Liver tuberculosis in Southern Taiwan: 15-years clinical experience;Tai;J Intern Med Taiwan,2008
4. [Pseudotumoral gallbladder tuberculosis];Soufi;Rev Med Interne,2011
5. Tuberculoma of the liver;Rosin;Tubercle,1978
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献