Rare Presentation of Sarcoidosis Involving the Terminal Ileum

Abstract

Introduction: Sarcoidosis is a multisystem granulomatous disease affecting many organs in the body. Diagnosing and distinguishing gastrointestinal involvement is quite challenging, given the low incidence (0.1-0.9%). Small bowel involvement is the least common among the other parts of the gastrointestinal system. This involvement can occur either separately, or as a part of disseminated gastrointestinal tract sarcoidosis. Case Report: We are presenting a case of a 53-year-old man who was recently diagnosed with pulmonary sarcoidosis. The patient initially presented to his primary care physician complaining of 3 weeks’ history of watery diarrhea. During that same time frame, the patient also complained of abdominal pain and weight loss. The patient was admitted to the hospital for further evaluation, initial studies including stool studies, stool cultures, and Clostridium difficile tests were negative. Liver function test was also negative. The patient underwent a CT Scan of the abdomen that showed signs of abdominal lymphadenopathy. The patient was scheduled for endoscopy and colonoscopy, both of which were negative for any signs of ulcerations or inflammation. Random biopsies were also taken from the colon and the terminal ileum. Despite conventional treatment with antidiarrheal medication, the patient continued to experience the same symptoms. A few days following his procedure, the biopsy results from the terminal ileum were reported, and showed tow areas of non-caseating granulomas in the mucosa, consistent with sarcoidosis. The patient was started on prednisone 30 mg daily. Within 2 days, the patient showed good response to the steroid treatment regarding the control of his diarrhea and abdominal pain. Conclusion: Small bowel sarcoidosis is a rare case that can manifest the same symptoms seen in other gastrointestinal tract disorders, such as Chron’s disease, Whipple’s disease, and TB. The diagnosis is usually confirmed by the biopsy and the presence of other organ involvement by the sarcoidosis. The prognosis is good, and most patients respond well to steroid treatment.