Introduction: Sarcoidosis is a multisystem non-necrotizing granulomatous disease which primarily involves the lungs in African Americans. Extraintestinal involvement, though rare, may involve both liver and luminal organs with a variety of presentations and severity. We present an asymptomatic case of systemic sarcoidosis diagnosed during a screening colonoscopy. Luminal disease is rare and is a diagnosis of exclusion, necessitating a thorough differential and evaluation.
Methods: A 37-year-old asymptomatic African-American female presented for high risk screening for colon cancer, with a strong family history of colon cancer. Colonoscopy revealed a single 3mm Paris-1s polyp removed completely via cold snare technique, and was otherwise unremarkable including the terminal ileum. Pathology revealed an inflammatory polyp with prominent submucosal non-necrotizing granulomatous inflammation. At follow-up, she revealed very mild decrease in exercise capacity but denied any other pulmonary symptoms. An EGD was performed for completion and was unremarkable including biopsies of stomach and small bowel. A CT chest found extensive mediastinal and hilar lymphadenopathy without lung nodule or parenchymal disease, as well as porta hepatis lymphadenopathy. An endobronchial ultrasound again revealed bilateral hilar lymphadenopathy, and mediastinal lymphadenopathy with transbronchial needle aspiration confirming hyalinized granulomas consistent with sarcoidosis. Discussion: Sarcoidosis is a global multi-organ systemic disease characterized by non-necrotizing granulomas. It primarily involves the pulmonary system and extrapulmonary disease is less than 10% cases, including skin, eyes, liver, and luminal disease. This can become an infiltrative, possibly fatal, disease of the liver and heart. Gastric sarcoidosis may result in isolated ulcers, gastritis, and friable mucosa with granulomas, or a more diffuse infiltration pattern which may result in fibrosis and stenosis. Due to the rarity of colonic sarcoid, other diseases need to be ruled out including tuberculosis, syphilis, inflammatory bowel disease, Whipple’s disease, diffuse Histoplasma, and H. Pylori infection from the stomach. ACE levels are not recommended to diagnose sarcoid, however may help differentiate with IBD if there is isolated colonic or small bowel disease. Our patient was treated with a slow taper of prednisone 20mg and 200mcg fluticasone furoate inhalation powder with respiratory symptom resolution.
Paris-1s colon polyp histologic analysis diagnosing asymptomatic systemic sarcoidisos. This is an inflammatory polyp with prominent submucosal non-necrotizing granulomas (A) with moderate granulomatous inflammation (B).
Chest Computed Tomography transverse (C) and coronal (D) images revealing bilateral hilar lymphadenopathy (arrows) in an asymptomatic case of systemic sarcoidosis
Disclosures: Andrew Simmelink indicated no relevant financial relationships. Brittany Seminara indicated no relevant financial relationships.