Colonic sarcoidosis: Unusual onset of a systemic disease

Abstract

Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology that has the potential to involve every tissue in the body. Sarcoidosis in the gastrointestinal system, and particularly the colon, is very rare. Here, we report the case of a 57-year-old man with no previous diagnosis of sarcoidosis who presented with new onset of abdominal pain and constipation. A colonoscopy revealed that the abdominal pain was caused by an obstructing lesion in the cecum-ascending colon and lacked a clear histologic diagnosis. Radiologic investigation revealed concentric wall thickening of the cecum-ascending colon with multiple satellite lymphadenopathies, highly suggestive of a malignancy. The patient underwent a laparotomy and a right hemicolectomy was performed. A diagnosis of colonic sarcoidosis was made after the resected specimen was examined. Additionally, a chest computed tomography scan revealed lung involvement with atypical radiologic features in the absence of respiratory symptoms. Only histologic examination of the surgical specimen can yield a diagnosis of gastrointestinal sarcoidosis due to the non-specificity of endoscopic and radiologic findings.

Making a Positive Diagnosis of Intestinal Tuberculosis with the Aid of New Biologic and Histologic Features: How Far Have We Reached?

“…Thoracic adenopathy, other systemic features, and a negative TB culture may lead to suspicion of this relatively rare disease. However, histological examination of large specimens may yield the final diagnosis [6-8]. …”

Extensive Abdominal Sarcoidosis Without Pulmonary Manifestation

“…A previous case report showed extensive involvement of the gastrointestinal tract with atypical pulmonary features revealed by chest imaging. 13 Abdominal sarcoidosis is treated differently than intrathoracic sarcoidosis, and treatment is determined by the severity of symptoms, organ involvement, and surgical candidacy. Some patients with isolated organ involvement such as the spleen or parts of the greater omentum have been treated surgically.…”

Isolated Gastrointestinal Sarcoidosis Involving Multiple Gastrointestinal Sites Presenting as Chronic Diarrhea

“…Because sarcoidosis of the colon is rare and may mimic many other diseases, it is important to rule out other differential causes, especially those which cause granulomatous disease (such as tuberculosis, syphilis, inflammatory bowel disease, Whipple’s disease), fungal infections (such as Histoplasma ), and H. pylori 1,4,5. Gastric sarcoidosis, specifically, can mimic peptic ulcer disease, Ménétrier’s disease, hypertrophic gastritis, Mycobacterium infection, syphilis, histoplasmosis, cancer, lymphoma, and Langerhans cell histiocytosis 7…”

“…The stomach is the most frequently affected hollow organ 2,3. GI sarcoidosis presents subclinically, with patients reporting symptoms only 0.1–0.9% of the time 4. The incidence of intestinal involvement is unknown, although it is estimated at less than 1% and there are only a few reported cases 1,5.…”