Variceal Bleeding: An Uncommon Presentation of Hepatic Sarcoidosis-Related Portal Hypertension

Hepatic sarcoidosis is a well-described manifestation of sarcoidosis, a multisystem granulomatous disorder, though it infrequently causes clinically significant liver disease. In select cases, it may progress to severe complications, including portal hypertension and variceal bleeding, even in the absence of cirrhosis. Diagnosis is challenging owing to nonspecific symptoms, laboratory abnormalities, and imaging findings, and histologic confirmation is needed with noncaseating granulomas. This case highlights hepatic sarcoidosis as an underrecognized cause of noncirrhotic portal hypertension and emphasizes the importance of multidisciplinary evaluation to guide diagnosis and management.