A Worrisome Liver Doppelgänger

Question: A 63-year-old woman with a history of advanced sarcoidosis with involvement of both spleen and duodenum was admitted to our intensive care unit because of an acute liver injury. Sarcoidosis in the past years had presented an aggressive clinical course with many flares and had been managed with multiple treatments including prednisone, mycophenolate, methotrexate, and infliximab. Secondary to the splenic infiltration, she had occasionally presented with mild pancytopenia that normalized with treatment.