Sarcoidosis is a multisystemic disease of unknown cause that is diagnosed on the basis
of the history and demonstration of granulomas in involved organs in patients before
the age of 50 years; peak incidence occurs between the ages of 20 and 39 years [1]. The gastrointestinal tract is involved in less than 1 % of all cases of sarcoidosis
[1]
[2]. The stomach is the most commonly involved part of the gastrointestinal tract, but
reported locations range from the esophagus to the rectum. Sarcoidosis is usually
diagnosed incidentally [1]
[2]
[3].
The patient is a 36-year-old black woman born in the United States who presented with
abdominal pain. She was well until approximately 3 weeks prior to admission when she
had postumbilical hernia repair. Three days before admission she experienced abdominal
bloating, diarrhea, and severe abdominal pain. Her past medical history was positive
for a diagnosis at another institution of inconsequential polyp disease. Her family
history showed multiple family members with malignancy, but also family members with
sarcoidosis, mostly cousins. On examination, the patient had marked tenderness on
the periumbilical region and hyperactive bowel sounds but no peritoneal signs. Results
of routine hematology and biochemistry investigations, including liver enzymes, were
all within normal limits except for mild hyperkalemia. Abdominal computed tomography
(CT) showed extensive retroperitoneal and mesenteric lymphadenopathy. Colonoscopy
showed small sessile polyps throughout the colon ([Fig. 1]). Colon random biopsy showed colonic mucosa with multifocal giant-cell and epithelioid
confluent granulomata ([Fig. 2]), suggestive of sarcoidosis. PAS and acid-fast stains were negative for fungal and
acid-fast organisms. Pankeratin stain was negative for metastatic carcinoma. Chest
CT showed numerous nodules in both lungs with mild mediastinal and hilar adenopathy
([Fig. 3]). Right supraclavicular lymph node biopsy showed diffuse noncaseating granulomatous
inflammation. Soft tissue CT of the neck showed scattered bilateral cervical lymphadenopathy
with homogeneous enhancement suggesting reactive lymphadenopathy. Lymph nodes varied
in size from 15 to 18 mm.
Fig. 1 Colonoscopic view of small sessile polyps throughout the colon.
Fig. 2 Colon random biopsy showed colonic mucosa with multifocal giant-cell and epithelioid
confluent granulomata.
Fig. 3 Chest CT showed numerous nodules in both lungs with mild mediastinal and hilar adenopathy.
Endoscopy_UCTN_Code_CCL_1AD_2AJ
