2736 A Rare Case of Gastric Sarcoidosis

Abstract

INTRODUCTION: Gastrointestinal involvement in sarcoidosis is quite rare, in which it either presents as systemic disease or as an isolated case. It can mimic other disease processes, including malignancy, gastritis, and peptic ulcer disease. We present a 28-year-old female who had weight loss, epigastric pain, and early satiety found to have symptomatic gastric sarcoidosis that rapidly improved with steroid treatment. CASE DESCRIPTION/METHODS: A 28-year-old with no past medical history presented to the emergency department with complains of epigastric pain, weight loss, and early satiety. She had onset of pain in epigastrium described “like ringing out a washrag”, better with eating and marked early satiety. She was found to have an iron level of 11 with period less heavy than years ago. Vitals showed Wt 142 lb, BP 118/66, Pulse 85, and O2 sat 98% on room air. Physical exam was significant for only epigastric tenderness and bilateral edema. Labs showed hemoglobin 8.9, MCV 57, iron level 11, Na 138, Cl 108, and CO2 20. EGD showed body and antrum with markedly thickened, pale appearing, firm/friable folds. Colonoscopy showed no abnormalities. Gastric fold biopsies showed noncaseating epithelioid granulomatous infiltrate suggestive of sarcoidosis. AFB and GMS fungal stains showed no microorganisms and H. Pylori was negative. The patient was initially started on prednisone 40 mg daily tapering dose and had near immediate resolution of symptoms with increase in weight. DISCUSSION: Sarcoidosis is a systemic disease characterized by pathognomonic formation of noncaseating granulomas with rare gastrointestinal involvement. Infection, malignant, and inflammatory causes must be ruled out as part of the broad differential before making diagnosis of sarcoidosis. Patients typically have symptoms of early satiety, nausea, and weight loss. Gross findings on endoscopy typically include mucosal nodularity, thickened and enlarged irregular folds, and deformity of the antrum. For recurrence of symptoms, surveillance endoscopy is warranted to examine extent of disease. As in our patient, there is excellent response to glucocorticoid treatment and patients should be monitored clinically with tapering doses.