Dysphagia: A Rare Presentation of Sarcoidosis

Abstract

Gastrointestinal (GI) sarcoidosis is a rare manifestation of this multi-systemic granulomatous disorder. Esophageal involvement is extremely rare and there have been few case reports about this. Our article reports a case of esophageal sarcoidosis in which dysphagia was the main presenting symptom. The main initial treatment of symptomatic sarcoidosis in general and pulmonary sarcoidosis in specific usually involves corticosteroids, however, there are no specific guidelines for the management of GI sarcoidosis. Surprisingly, or maybe not, in our case, the dysphagia did not improve with steroid therapy which prompted further investigations as well as endoscopic intervention.

A Rare Presentation of Sarcoidosis: Dysphagia, Pancytopenia, and Acute Renal Failure

“…Dysphagia has been reported to be the most common symptom in patients with esophageal sarcoidosis and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement [1]. Other clinical manifestations among patients include weight loss, abdominal pain, odynophagia, hoarseness of voice/dysphonia, and anemia (Table 2) [5]. The lower esophagus is the most commonly involved (56.5%).…”

“…The lower esophagus is the most commonly involved (56.5%). The esophageal involvement in sarcoidosis can be classified into four types depending upon the level of involvement and the layer of involvement: superficial mucosal involvement, involvement of the esophageal musculature, direct myenteric involvement, and extrinsic compression [2,5]. Upper GI endoscopy along with histopathological evaluation of the biopsy showing granulomatous infiltration is the key to the diagnosis of esophageal sarcoidosis, and negative special stains for mycobacteria and fungi are required to establish the diagnosis, in addition to evidence of systemic sarcoidosis [3,4].…”