A rare case of symptomatic gastric sarcoidosis

Gastric sarcoidosis: Rare revealing feature of systemic sarcoidosis

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.

Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

The focus of this review is current knowledge about the epidemiology, clinical manifestations, diagnosis, and treatment of both pulmonary sarcoidosis and extrapulmonary sarcoidosis. Although intrathoracic involvement is the hallmark of the disease, present in over 90% of patients, sarcoidosis can affect virtually any organ. Clinical presentations of sarcoidosis are diverse, ranging from asymptomatic, incidental findings to organ failure. Diagnosis requires the presence of noncaseating granuloma and compatible presentations after exclusion of other identifiable causes. Spontaneous remission is frequent, so treatment is not always indicated unless the disease is symptomatic or causes progressive organ damage/dysfunction. Glucocorticoids are the cornerstone of treatment of sarcoidosis even though evidence from randomized controlled studies is lacking. Glucocorticoid-sparing agents and biologic agents are often used as second- and third-line therapy for patients who do not respond to glucocorticoids or experience serious adverse effects.

Sarcoidosis Involving the Gastrointestinal Tract: Diagnostic and Therapeutic Management

Involvement of the gastrointestinal (GI) tract is an infrequent extrathoracic presentation of sarcoidosis. We reviewed 305 cases of GI involvement reported in 238 patients, in whom GI sarcoidosis was the first sign of the disease in half the cases. The disease does not affect the GI tract uniformly, with a clear oral-anal gradient (80% of reported cases involved the esophagus, stomach, and duodenum). Clinicopathological mechanisms of damage may include diffuse mucosal infiltration, endoluminal exophytic lesions, involvement of the myenteric plexus, and extrinsic compressions. Ten percent of patients presented with asymptomatic or subclinical disease found on endoscopy. The diagnosis is relevant clinically because 22% of cases reviewed presented as life threatening. In addition, initial clinical/endoscopic findings may be highly suggestive of GI cancer. The therapeutic approach is heterogeneous and included wait-and-see or symptomatic approaches, glucocorticoid/immunosuppressive therapy, and surgery. Sarcoidosis of the gut is a heterogeneous, potentially life-threatening condition that requires a multidisciplinary approach and early clinical suspicion to institute personalized therapeutic management and follow-up.

Gastric and pulmonary sarcoidosis complicated by hypercalcemia and acute renal failure: Case report and literature review

Gastric sarcoidosis is a very rare manifestation of sarcoidosis. Only few case reports have been described in the literature. We present a case of coexisting gastric and pulmonary sarcoidosis in a 56-year-old female, who presented with gastrointestinal symptoms. Gastric mucosal biopsies, transbronchial needle aspiration, and endobronchial mucosal biopsies revealed noncaseating granulomas. This case report emphasizes on early evaluation of other organ system and initiation of treatment.

[An unusual case of duodenal sarcoidosis]

INTRODUCTION

Sarcoidosis is a systemic granulomatous disorder of unknown aetiology. It may rarely affect the gastrointestinal tract.

CASE REPORT

We reported a 54-year-old woman with a delayed diagnosis of duodenal sarcoidosis. She presented with gastric and right upper abdominal pain associated with vomiting and marked weight loss. Abdominal computed tomographic scan showed non-compressive retroperitoneal lymph nodes and histological examination revealed non-caseating epithelioid granulomas typical of sarcoidosis. Diagnosis of duodenal sarcoidosis was obtained at the third gastroscopy. The patient's condition improved quickly with corticosteroid therapy.

CONCLUSION

Gastrointestinal sarcoidosis should be looked for in patients with digestive symptoms and another sarcoid localisation. Furthermore, it is important to repeat gastroscopy to confirm diagnosis because treatment improved most patients.