Hepatic Sarcoidosis — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineHepatic SarcoidosisRACP Adult Medicine

A 50-year-old man with sarcoidosis develops hepatic granulomas causing cholestatic liver function derangement. His ALP is 650 U/L and bilirubin is 55 µmol/L. He has no other organ involvement requiring treatment. What is the most appropriate treatment?

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Correct answer: A — Prednisolone

Hepatic sarcoidosis causing significant cholestasis (elevated ALP, bilirubin) warrants treatment with systemic corticosteroids. Prednisolone 20–40 mg daily with gradual taper over months is the standard approach. Azathioprine or methotrexate are steroid-sparing agents for relapsing disease. UDCA has limited evidence in sarcoid hepatopathy but may provide symptomatic benefit for pruritus. Untreated hepatic sarcoid can progress to cirrhosis and portal hypertension in a minority of patients.

Reference: eTG – 2025 – Respiratory; eTG – 2025 – Gastrointestinal