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A6502 - Symptomatic Gastric Sarcoidosis: A Rare Entity
Author Block: B. Bhattarai1, J. Lamichhane2, O. Abdulfattah1, P. B. Datar3, A. Lixon1, S. Dahal3, D. Enriquez1, M. Schmidt1, J. B. K. Quist1; 1Pulmonary Medicine, Interfaith Medical Center, Brooklyn, NY, United States, 2Internal Medicine, St.John's Riverside Hospital, Yonkers, NY, United States, 3Internal Medicine, Interfaith Medical Center, Brooklyn, NY, United States.
INTRODUCTION: Gastro-intestinal tract involvement in sarcoidosis is a rare and often silent. Symptomatic gastric involvement as initial presentation of sarcoidosis has been rarely reported.
CASE REPORT: 29-year-old female presented with chronic intermittent epigastric abdominal pain for 6 months. The pain was burning in nature with no radiation and was worsened by food intake. It was associated with nausea and multiple episodes of non-bilious vomiting. Except for occasional cough and exertional shortness of breath, the review of system were negative. She had multiple visits to the emergency department in the last six months for similar complaints. Past medical history was significant only for cholecystectomy secondary to cholelithiasis four years back. Vital signs at presentation were within normal limits, and the rest of the physical examinations were within normal limits except for mild epigastric tenderness without any rebound, guarding or rigidity. Lab tests were significant for normocytic normochromic anemia with hemoglobin of 10.7 g/dL and hematocrit of 33.7%. Serum calcium was 8.7 mg/dL (normal 8.9-10.3 mg/dL). White blood cell count and metabolic panel were within normal limits. Abdominal sonogram was unremarkable. The patient was admitted for acute abdominal pain, intractable vomiting and treated with intravenous fluids, proton pump Inhibitor and analgesics. Computed tomography (CT) scan of the abdomen showed unremarkable pancreas, moderate para-umbilical hernia containing fat and mild stranding, and a 7 mm pulmonary nodule in the right lower lobe. Subsequent CT scan of the chest showed multiple bilateral pulmonary nodules ranging from 2 to 7 mm with enlarged mediastinal and hilar lymph nodes. Surgical repair of the hernia was done along with an esophagogastroduodenoscopy that showed mild gastritis while stomach biopsy showed acute and chronic inflammation with non-caseating granuloma. Subsequent bronchoscopy with transbronchial biopsy showed benign lung tissue with non-necrotizing granuloma. So the patient was diagnosed to have stage 2 pulmonary sarcoidosis and gastric sarcoidosis. Meanwhile the patient’s acute symptoms improved and was discharged with plans to start corticosteroid as outpatient. DISCUSSION: Sarcoidosis is a multisystem disease and can involve any organ. GI tract involvement, however, is rare and often silent. Symptomatic gastric involvement is only seen in 0.9% of patients with systemic disease, and may present with non-specific symptoms. Physicians need to be aware of this rare presentation of sarcoidosis.