Symptomatic gastric sarcoidosis with multiple antral ulcers

Sarcoidosis is a systemic granulomatous disease of unknown etiology that is characterized by the formation of noncaseating granulomas. Although it affects many systems, the disease has a predilection for the intrathoracic structures. Almost 90 % of sarcoidosis patients have granulomas in the lungs and/or hilar nodes [1]. Gastrointestinal tract involvement in sarcoidosis is rare. Gastric sarcoidosis, particularly involving the antrum, affects approximately 10 % of patients with systemic disease [2]. Gastrointestinal sarcoidosis commonly occurs subclinically, with clinical manifestations present in only 0.1 % –  0.9 % of patients with the disease. This is a rare case report of an individual with symptomatic gastric sarcoidosis.

A 66-year-old woman followed up for eye and lung sarcoidosis suffered nausea, epigastralgia, and weight loss. She underwent bronchoscopy and transbronchial biopsy which showed a noncaseating epithelial cell granuloma, and bronchoalveolar lavage which demonstrated a lymphocytic pattern suggestive of sarcoidosis. On upper endoscopy, several superficial ulcers were evident in the antral region ([Fig. 1]).

Fig. 1 Gastroscopic finding. Multiple ulcers of the antrum, irregular-shaped or serpiginous aphthoid.

Mucosal biopsies from the antral ulcers showed noncaseating granulomas ([Fig. 2]).

Fig. 2 Histopathologic finding. A noncaseating epithelioid-cell granuloma including giant cells, surrounded by the infiltration of lymphocytes and proliferation of fibroblastic cells (H&E stain, × 100).

The specimen was negative for Helicobacter pylori. Tests using special stains for fungi (methenamine silver), acid-fast bacilli (Ziehl-Neelsen), and treponema (Warthin-Starry) gave negative results. This case illustrates the importance of endoscopy examinations for patients with sarcoidosis, particularly those with intractable primary lesions, in order to detect gastrointestinal sarcoidosis.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AC

References

• 1 James D G, Nevilli E, Siltzbach L E. A worldwide review of sarcoidosis.  Ann N Y Acad Sci. 1976;  278 321-328
• 2 Fireman Z, Sternberg A, Yarchovsky Y. et al . Multiple antral ulcers in gastric sarcoid.  J Clin Gastroenterol. 1997;  24 97-99