ILEOCOLIC INTUSSUSCEPTION: A RARE CASE REPORT OF MULTI-SYSTEMIC SARCOIDOSIS

Abstract

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sarcoidosis is a chronic inflammatory granulomatous disease of unclear etiology with multi-organ involvement, commonly affecting pulmonary and cutaneous systems. Gastrointestinal (GI) tract is rarely involved, if so, usually in stomach. This case highlights a rare involvement of small intestine in multi-systemic sarcoidosis management. CASE PRESENTATION: 56-year old male with history of pulmonary and cutaneous sarcoidosis and nephrolithiasis, without major surgical history presented to ED for acute generalized non-radiating left lower abdominal pain followed by persistent non-bilious, non-bloody vomiting and non-bloody diarrhea, within 24 hours. Patient had preceding subjective fever, chills, rigors, and diaphoresis. Medications included prednisone, levothyroxine, citalopram, omeprazole and rosuvastatin. Vital signs were within normal limits. Physical exam showed distended abdomen, bilateral lower quadrant tenderness and rebound tenderness at the supra-umbilical region with hypoactive bowel sounds. Laboratory studies showed a leukocytosis with left shift, elevated levels of creatinine, calcium, and alkaline phosphatase. He underwent emergent ileocectomy after CT abdomen and pelvis that demonstrated ileocolic intussusception with small bowel obstruction. Surgical biopsy revealed inflammatory non-caseating granuloma. GMS stains and AFB were negative. Diagnosis of GI Sarcoidosis was made. DISCUSSION: Although the clinical manifestation of GI sarcoidosis is rare, one can aid early diagnosis by thorough clinical picture, histopathological evidence of non-caseating granuloma and exclusion of other causes of similar clinical presentations. CONCLUSIONS: GI Sarcoidosis requires a high index of suspicion. Only 0.1-0.9 % of Sarcoidosis patients have GI manifestations. Extrapulmonary and multiple system sarcoidosis should be considered in patients with compatible clinical picture and histopathological evidence of non-caseating granuloma in any accessible biopsy site. Reference #1: Ghrenassia E, Mekinian A, Chapelon-Albric C, et al. Digestive-tract sarcoidosis: French nationwide case-control study of 25 cases. Medicine (Baltimore). 2016;95(29):e4279. doi:10.1097/MD.0000000000004279 Reference #2: Stemboroski L, Gaye B, Makary R, Monteiro C, Eid E. Isolated Gastrointestinal Sarcoidosis Involving Multiple Gastrointestinal Sites Presenting as Chronic Diarrhea. ACG Case Rep J. 2016;3(4):e198. Published 2016 Dec 21. doi:10.14309/crj.2016.171 DISCLOSURES: No relevant relationships by Nancy Bethuel, source=Web Response No relevant relationships by Yuri Choi, source=Web Response No relevant relationships by Nazir Lone, source=Web Response