Gastric Sarcoidosis: A Rare Clinical Presentation

Gastrointestinal (GI) sarcoidosis is a very rare disease, which clinically presents along with systemic disease or as an isolated finding. Gastric sarcoidosis is the most common form of GI sarcoidosis. Symptomatic gastric sarcoidosis is rare and only few case reports have been described in the literature with well-documented histological evidence of noncaseating granulomas. We present an interesting case of gastric sarcoidosis in a 39-year-old Caucasian man with symptoms of epigastric pain and profound weight loss. His endoscopic gastric mucosal biopsies revealed noncaseating granulomas consistent with gastric sarcoidosis. Treatment with oral steroids alleviated his symptoms with no recurrence in 2 years. Gastric sarcoidosis should be considered in patients with history of sarcoidosis and GI symptoms. 1. Introduction Sarcoidosis is a chronic noncaseating granulomatous systemic inflammatory disease. Even though it was first described by Sir Jonathan Hutchinson 140 years ago, to date the etiology is unclear [1]. It can involve any organ, with pulmonary involvement being the most common. Gastrointestinal (GI) involvement is very rare and may present along with systemic disease or as an isolated finding. Gastric sarcoidosis, first described by Schaumann in 1936, is the most common form of GI tract sarcoidosis [2]. Symptomatic GI involvement occurs only in 0.1 to 0.9% of patients with systemic disease [3]. In the literature there are only 26 reported cases of symptomatic gastric sarcoidosis with well-documented histological evidence of noncaseating granulomas consistent with sarcoidosis [4]. 2. Case Presentation A 39-year-old Caucasian man who is a race car driver by profession presented to the emergency department with a six-month history of nausea, vomiting, and profound weight loss along with one-month history of progressively increasing epigastric pain. His past history included incidental diagnosis of sarcoidosis in spleen and gall bladder one year ago when he met with a motor vehicle accident and underwent elective cholecystectomy and splenectomy. Physical examination was remarkable for mild tenderness in the epigastric region. Rest of the examination was unremarkable. Complete blood counts, comprehensive metabolic panel, and chest X-ray were normal. Computed tomography scan of the abdomen and pelvis revealed extensive adenopathy in the mesentery and retroperitoneum (Figure 1(b)). Esophagogastroduodenoscopy done during the hospital stay was significant for poor gastric insufflation and the wall of the stomach looked very rigid with diffuse erythema