Purpose: A 42-year-old African-American male with PMH of recently diagnosed hereditary hemochromatosis presented to a GI clinic complaining of abdominal pain, cramps, associated diarrhea and dyspepsia but denied any bloody stools, fever, weight loss or nausea/vomiting. Vital signs were stable and physical exam was benign. There was no palpable adenopathy, breath sounds were clear bilaterally, no murmurs on cardiovascular auscultations, no abdominal tenderness, no joint abnormalities and no appreciable skin rashes on examination. CMP showed mildly elevated AST/ALT, and stool analysis for fecal leukocytes, ova and parasites, culture and Clostridium difficile were negative. Upper GI endoscopy was positive for hiatus hernia, gastric mucosal abnormalities characterized by congestion, erythema and erosions and duodinitis. No ulcerations, nodular irregularities, segmental mucosal thickening, non distensibility mimicking linitis plastic or mucosal polyps were seen. Biopsies of these areas were sent to pathology. Colonoscopy performed revealed erythematous transverse colon and rectum, but was otherwise unremarkable. Biopsies were also sent to pathology. Biopsy report revealed chronic inflammatory changes and non-caseating granulomas involving the stomach, terminal ileum, colon and rectum. There was no evidence of acid-fast bacilli, fungi or H. pylori. Although the patient had not lived in an endemic area, histoplasma urine antigen was measured and negative. Liver biopsy from months earlier was negative for non-caseating granulomas, but consistent with changes associated with Hemochromatosis. CT chest showed no acute or chronic pulmonary disease. There were no hilar adenopathy and the lungs were clear bilaterally without infiltrates, volume loss or mass lesions. CT abdomen and pelvis was significant for hepato-splenomegaly, but negative for retroperitoneal mesenteric or pelvic lymphadenopathy. Sedimentation rate was within normal limits, but angiotensin converting enzyme was elevated. Chrohn's disease was ruled out because there was no evidence of perianal disease, fistulas or strictures, normal ESR and CRP and elevated ACE levels. Gastric Sarcoidosis was highly suspected in this patient and he is pending an appointment with Rheumatology for management of sarcoidosis.Figure