Adnan Khan, DO1, Salaah Siddiqui, DO2, Joe Wheeler, MD3 1St. Louis University, Ballwin, MO; 2Baylor Scott & White Health, Dallas, TX; 3St. Louis University, St. Louis, MO
Introduction: Digestive tract sarcoidosis is a very rare systemic granulomatosis disease that presents with multiple abnormal findings. Sarcoidosis commonly affect the lungs and chest lymph nodes but can also affect other organs such as the heart, skin, central nervous system. In our case, we will discuss the unusual presentation of Digestive tract sarcoidosis .
Case Description/Methods: A 44 year old male with a history of diabetes presented to the emergency department with 6 a month history of nausea, vomiting, heart burn, and 20 pound weight loss. On exam; the patient was noted to have right lower quadrant abdominal tenderness. Laboratory findings were remarkable for elevated calcium and vitamin D levels. The rest of the labs were unremarkable. CT Chest Abdomen and Pelvis were remarkable for thickening of the lower esophagus. Esophagogastroduodenoscopy was performed and showed grade C esophagitis, no evidence of ulcers, and a rigid stomach wall with diffuse erythema. The biopsy result showed several small noncaseating granulomas composed of epithelioid, histiocytes, and multinucleated giant cells without any evidence of dysplasia or intestinal metaplasia. Biopsy results for helicobacter pylori, mycobacterium and fungal stains were all negative. Prednisone was started which showed immediate improvement in the patient’s symptoms. At the 4 month follow up, the patient did not have any recurrence of symptoms.
Discussion: Digestive tract sarcoidosis is a rare extrathoracic presentation of sarcoidosis. The disease pattern is very unusual in that it does not fully affect the GI tract uniformity. In our case, the patient’s disease pattern was localized in the stomach. Symptomatic patient’s will presents with dyspepsia, epigastric pain, and weight loss. However, most patient’s with DTS are asymptomatic. When symptoms do occur it is imperative to perform biopsy to look for evidences of non caveating granulomas. A deep mucosal or full thickness biopsy is recommended, as superficial biopsies may be non-specific. It is imperative to rule out infections and other etiologies of granulomas with appropriate staining. Management consists of immunosuppressive and symptomatic therapy in patients with symptoms; asymptomatic patients are usually not treated. Duration of treatment is guided by clinical response. Our case demonstrates the importance of maintaining a broad differential and appropriate use of upper endoscopy for evaluation of dyspepsia with weight loss.
Disclosures: Adnan Khan indicated no relevant financial relationships. Salaah Siddiqui indicated no relevant financial relationships. Joe Wheeler indicated no relevant financial relationships.
Adnan Khan, DO1, Salaah Siddiqui, DO2, Joe Wheeler, MD3. P3110 - Digestive Tract Sarcoidosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.