Uncommon cause for anorexia and weight loss

Description

A 51-year-old woman presented with anorexia, abdominal fullness and weight loss of 1 year duration. There was a history of bilateral facial paralysis 4 years ago. There was no history of fever, cough polyarthralgia or altered bowel habits. Examination revealed bilateral lower motor neuron type facial palsy and non-tender hepatomegaly. Haematological workup revealed normocytic normochromic anaemia (9 g/dL) with an elevated erythrocyte sedimentation rate (85 mm/hour) and a WCC of 8800/cu.mm. Her blood biochemistry showed increased levels of alkaline phosphatase—685 U/L (40–125), gamma-glutamyltransferase of 1251 U/L (<38) and angiotensin-converting enzyme—102 U/L (8–52). A CT scan of the thoraco-abdomen displayed hepatomegaly with multiple ill-defined hypodense nodules, splenomegaly with hypodense lesions (figure 1). There was evidence of hilar lymphadenopathy. A liver biopsy was performed which showed non-necrotising granulomatous inflammation with lymphohistiocytic aggregates. A diagnosis of sarcoidosis was made in the view of symptoms, elevated ACE and multiorgan involvement (figure 2).

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