The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Hepatic Sarcoidosis Presenting as 
Cholestatic Liver Injury Exacerbated by 
Nitrofurantoin Use 

SJ Halloran, M31*, S Stanley, DO1, J. Burlen, MD1, Y. Alastal, MD, MPH1 

1Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: sean.halloran@rockets.utoledo.edu

Published: 05 May 2023 

Introduction: The liver is a common site of involvement in patients with sarcoidosis with 50-80% of 
patients having hepatic involvement at diagnosis. However, it is largely asymptomatic and <15% of 
patients present with symptoms of hepatic injury. We report a patient with hepatic sarcoidosis presenting 
as cholestatic liver injury exacerbated by nitrofurantoin use. 

Case Presentation: A 67-year-old African American female presented due to 1 week of diffuse itching, 
shortness of breath, and scleral icterus with darkened urine. Medical history was significant for type 2 
diabetes, hypertension, and hyperlipidemia. Patient denied alcohol use and was a lifetime non-smoker. 
Family history was significant for sarcoidosis in father. Notably, the patient took nitrofurantoin for a 
UTI one week prior to presentation. Lab results showed elevated direct bilirubin 5.2, total bilirubin 8.8, 
ALK PHOS 950, ALT 126, and AST 229. Ultrasound of the liver and MRCP showed hepatic steatosis 
and gallbladder sludge. Liver biopsy showed cholestatic granulomatous hepatitis with stage 2-3 bridging 
fibrosis. This patient’s presentation was deemed most consistent with hepatic sarcoidosis. Nitrofurantoin 
is a well-known cause of hepatic injury, but has rarely been reported as causing granulomatous disease 
exacerbating underlying sarcoidosis.  

Discussion: While the liver is a common site of involvement for sarcoidosis, the majority of patients are 
asymptomatic. Hepatotoxic drugs can exacerbate symptoms and lead to diagnosis. In those with clinical 
symptoms, a cholestatic pattern is most common. Glucocorticoids and methotrexate are common 
treatments. However, there is currently a lack of randomized controlled studies regarding treatment and 
surveillance of hepatic sarcoidosis. 

https://dx.doi.org/10.46570/utjms.vol11-2023-673 

https://dx.doi.org/10.46570/utjms.vol11-2023-673
mailto:sean.halloran@rockets.utoledo.edu