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A rare case of severe liver disease in a patient with systemic sarcoidosis is reported. The liver pathology progressed from sarcoid granulomas early in the course to chronic active hepatitis and cirrhosis with complicating portal hypertension and bleeding esophageal varices. The literature on portal hypertension due to hepatic sarcoidosis is reviewed and the role of coexisting disease, portasystemic shunts, and steroid therapy is discussed.
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