Isolated Gastrointestinal Sarcoidosis Involving Multiple Gastrointestinal Sites Presenting as Chronic Diarrhea

Abstract

Sarcoidosis is a chronic and systemic disorder characterized by the formation of non-caseating granulomas. Very few cases of isolated gastrointestinal sarcoidosis have been reported, and even fewer, if any, report gastrointestinal sarcoidosis within multiple gastrointestinal sites concomitantly. We present a 42-year-old white man with chronic diarrhea and abdominal pain for more than 3 years. Mucosal biopsies revealed non-caseating microgranulomas in the stomach, throughout the small intestine, colon, and rectum. Prednisone therapy was initiated with a rapid improvement in symptoms and complete resolution of diarrhea within 3 weeks.

A life–threatening small bowel obstruction as onset of an unknown sarcoidosis: A case report

“…Peritoneal sarcoidosis is even more unusual with few anecdotal cases reported in literature and hemorrhagic ascites is extremely rare [ [12] , [13] , [14] ]. The most common reported manifestation are colicky abdominal pain, chills and feverishness [ [15] , [16] , [17] ], non-specific constitutional symptoms and obstruction may be present as well mimicking an intestinal cancer [ [18] , [19] , [20] ].…”

Erken Yaşta Malabsorpsiyon ile Başvuran Gastrointestinal Sarkoidoz

“…The incidence of small and/or large bowel involvement in sarcoidosis is not known, and there are only a few reported cases. It has been stated that the small intestine was the least commonly involved site ( 7 , 8 ). The differential diagnosis of gastrointestinal sarcoidosis includes several more commonly seen diseases such as CD, celiac disease, CGD, fungal infection, and intestinal tuberculosis ( 5 , 7 ).…”

“…It has been stated that the small intestine was the least commonly involved site ( 7 , 8 ). The differential diagnosis of gastrointestinal sarcoidosis includes several more commonly seen diseases such as CD, celiac disease, CGD, fungal infection, and intestinal tuberculosis ( 5 , 7 ). Sarcoidosis of the colon is also very rare and may mimic CD, thus the differentiation of the two diseases is particularly difficult.…”

“…Histopathologic and clinical findings, which may favor the diagnosis of sarcoidosis rather than CD, include mucosal involvement instead of transmural inflammation, absence of perianal disease or fistulas, and elevated serum ACE levels ( 4 ). The presence of non-caseating granuloma consisting of multinucleate giant cells is the gold standard for the diagnosis of sarcoidosis ( 7 ). Moreover, confirmation of granulomas in extra-intestinal organs strongly supports the diagnosis of sarcoidosis ( 4 ).…”

“…The current therapy of choice for childhood sarcoidosis is corticosteroids, usually initiated at 1 to 2 mg/kg/day for 4 to 8 weeks as induction treatment ( 2 , 4 ). The disease activity is monitored clinically, radiographically, and through serum ACE levels ( 2 , 7 ). In our case, diarrhea improved, and serum ACE levels decreased to normal by the end of the first month of therapy.…”