Gastric sarcoidosis: Rare revealing feature of systemic sarcoidosis

Abstract

Gastric sarcoidosis is clinically manifest in less than 1% of patients with systemic disease. Stomach is the most commonly involved site. Clinical signs are non-specific. We report the case of a female patient presenting with abdominal pain with no associated symptoms. Upper gastrointestinal endoscopy showed mucosal erosions. Biopsy and histological study revealed the presence of a gastric non-caseating granuloma. No other involvement was found and infectious granulomatosis was ruled out. Patient was treated with corticosteroids with substantial improvement. One year later, the patient presented with respiratory symptoms and joint pain. Chest computed tomography showed multiple mediastinal and bilateral hilar lymphadenopathies. It also highlighted the presence of interstitial lung disease and a 1 cm pulmonary nodule. Histological examination of this nodule revealed non-caseating granuloma. Serum angiotensin converting enzyme level was elevated. Lymphocytic alveolitis was diagnosed with bronchoalveolar lavage. Systemic sarcoidosis with gastric involvement was suggested. Patient was treated with corticosteroids and developed a favourable clinical course. Isolated gastric sarcoidosis is a challenging diagnosis. Histological findings are the key to diagnosis. Other granulomatous diseases need to be excluded especially infectious diseases before establishing the diagnosis of sarcoidosis. Corticosteroids are used in treating gastric sarcoidosis, yet no guidelines exist for the treatment of this rare condition.

Keywords: Gastrointestinal tract; Granuloma; Sarcoidosis.