Lupus hepatitis, more than just elevated liver enzymes.

Systemic lupus erythematosus (SLE), a multisystem autoimmune inflammatory disease, may involve any organs, including the liver. Liver involvement in SLE is not part of the American College of Rheumatology criteria and is relatively rare. Liver disease is usually mild, manifesting as subtle elevation of liver enzymes. Jaundice and hepatomegaly can be seen in some patients; advanced liver disease with cirrhosis is extremely rare. Precise pathology remains obscure. SLE may cause non-specific changes, including hepatocellular, cholestatic, or vascular changes. Alcohol, drugs, viral infections, metabolic disorders, autoimmune hepatitis, and other common causes of liver dysfunction should be excluded. Corticosteroids may expedite the recovery process, but may lead to non-alcoholic fatty liver disease and liver damage. Several large-scale multicentre studies have shown that liver involvement is not the major cause of morbidity and mortality in SLE patients. In this review, we discuss the pathogenesis, diagnosis, differential diagnosis, clinical manifestations, management, complications, and prognosis of lupus hepatitis.

Sarcoidosis presenting as necrotizing sinus destruction mimicking Wegener's granulomatosis.

We describe a 26-year-old man who developed nasal stuffiness and palatal destruction. Biopsy of a mass in the ethmoid sinus confirmed sarcoidosis. Treatment was initiated with oral steroid and methotrexate, with marked improvement in his symptoms. Although paranasal sinus involvement in sarcoidosis is rare it should be considered in differential diagnosis of diseases causing palatal or paranasal sinus destruction.