[Gastric sarcoidosis revealed by cutaneous follicular sarcoidosis]

Abstract

Background: Sarcoidosis is a disease well known to dermatologists because of the frequency of cutaneous involvement. Routine screening is performed for involvement of the lungs, lymph nodes, eyes, liver and heart. However, gastro-intestinal sarcoidosis is both rare and frequently silent, and it thus often goes undiagnosed. We report the case of a Caribbean woman whose cutaneous lesions allowed a posteriori diagnosis to be made of gastric sarcoidosis.

Patients and methods: A 45-year-old Caribbean woman consulted for diffuse erythematous or hypochromic, squamous and follicular micropapular lesions associated with inflammatory rheumatoid arthritis. Clinical examination and laboratory data led to a diagnosis of cutaneous sarcoidosis. It was later discovered that she had presented epigastric pains a few months earlier and that she had undergone gastroscopy and gastric biopsies. Histopathology had revealed non-caseating epithelioid-cell granulomas with giant cells, but no further exams were performed. The patient was diagnosed a posteriori with cutaneous-articular and gastric sarcoidosis.

Discussion: In contrast with hepatic involvement, which is frequent and well-known, sarcoidosis affecting the gastro-intestinal tract is rare and poorly known. This form of the disease is frequently clinically silent and is thus probably under-reported. The stomach is the site most frequently affected. Gastric sarcoidosis is seen in some 10% of patients with systemic sarcoidosis and is symptomatic in less than 1% of cases. It is important to diagnose these forms since they may be associated with a certain degree of morbidity.