Disseminated Sarcoidosis Resulting in Portal Hypertension and Gastrointestinal Bleeding: A Rare Presentation

A 41-year-old man was evaluated for an upper gastrointestinal bleed. He was stabilized and an upper esophagogastroduodenoscopy revealed gastritis and esophageal varices. A computed tomography (CT) scan of the abdomen showed hepatosplenomegaly and moderate ascites. Analysis of the ascitic fluid was consistent with portal hypertension. A liver biopsy demonstrated noncaseating granuloma consistent with sarcoidosis, there was no evidence of liver cirrhosis on pathology. Portal hypertension associated with sarcoidosis is rare; after the first reported case in 1949, 35 other cases have been reported in the English literature, with only 16 patients presenting with portal hypertension without evidence of liver cirrhosis. Our patient is among the small group reported to have sarcoidosis-related portal hypertension without evidence of liver cirrhosis. The present case illustrates the importance of recognizing an uncommon manifestation of sarcoidosis