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Case Reports
. 2020 Jun 11;7(6):e00394.
doi: 10.14309/crj.0000000000000394. eCollection 2020 Jun.

Gastroduodenal Sarcoidosis With Concomitant Cytomegalovirus Gastritis

Kristel Leung  1 , Usman Khan  2 , Iris Teo  3 , Paul James  1 , Jeffrey McCurdy  4
Affiliations
Case Reports

Gastroduodenal Sarcoidosis With Concomitant Cytomegalovirus Gastritis

Kristel Leung et al. ACG Case Rep J. .

Abstract

Gastrointestinal sarcoidosis in the absence of pulmonary disease is rare. Likewise, cytomegalovirus (CMV) reactivation in the stomach is also rare. We present a 67-year-old woman with symptomatic CMV gastritis and gastroduodenal sarcoidosis who presented with epigastric pain, nausea, and vomiting. Initial gastric biopsies revealed CMV gastritis. Repeat assessment demonstrated worsening disease requiring antiviral treatment. After this, further investigations into ongoing epigastric pain demonstrated noncaseating granulomas on repeat gastrointestinal biopsies. A diagnosis of sarcoidosis was established and treated with prednisone to resolution.

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Figures

Figure 1.
Figure 1.
Enlarged endothelial cells with typical cytoplasmic and nuclear inclusions (yellow arrows) in a background of ulcer with extensive neutrophilic inflammation, typical of cytomegalovirus gastritis.
Figure 2.
Figure 2.
(A) Gastric nodule in the fundus with surrounding inflammation.
Figure 3.
Figure 3.
(A and B) Gastric polypoid lesion with the area of ulceration at the incisura and duodenal polypoid lesion with persistent inflammation.
Figure 4.
Figure 4.
(A) Gastric mucosa (incisura) with well-formed granuloma (yellow circle) and extensive lymphoid and plasmacytic infiltrate within the lamina propria, along with reactive epithelial alterations. (B) Duodenal biopsy with duodenal mucosa with prominent lymphoplasmacytic infiltrate in the lamina propria, lymphocytes within the crypt epithelium, and reactive surface epithelial alterations.
Figure 5.
Figure 5.
Liver biopsy showing (A) well-formed granulomata (yellow circle) with associated lymphocytes in the liver parenchyma, (B) the granuloma (higher magnification), and (C) portal-based lymphocytic inflammation in the remaining liver.
See this image and copyright information in PMC

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