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HCV & Sarcoidosis

Dr Chung:

What would your recommendations for HCV treatment be for someone who has sarcoidosis. The liver enzymes are normal now. 1st liver biopsy showed non-caseating granulomas in April 2001 with mildly elevated liver enzymes. 2nd liver biopsy in May showed no granulomas and mild inflammation due to HCV with no fibrosis or cirrhosis. Mild skin sarcoid lesions are present on the legs which when biopsied were sarcoid. Other causes of granulomatous disease were ruled out. There is no lung involvement based on X-ray.

Would you recommend treating the sarcoidosis with prednisone? My GI doctor has told me that treating the HCV with interferon and ribovirin would make sarcoidosis worse and treatment of sarcoidosis with prednisone would make the HCV worse.

My GI doctor is sending me to a hepatologist for recommendations for treatment or not to treat. Do you have other recommendations for treatment of either disease?

answer from Dr Chung:

Given the absence of fibrosis on your liver biopsy, I would be inclined to hold off on antiviral therapy for HCV for now. It also appears that the sarcoid may be mild enough to hold off on treatment other than topical skin therapies. But make sure you consult adequately with knowledgable doctors. You may wish to pursue followup biopsies to see how things progress without treatment. RC Ask our Experts All Questions