SHM Converge Scientific Abstract ePoster Gallery-A Gastric Enigma: When Biopsy Tells a Bigger Story

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This case describes a 36-year-old African American man who presented with 3 weeks of epigastric pain radiating to the left lower back, decreased appetite, unintentional weight loss, reflux, nausea, and daily episodes of dark non-bloody vomiting. He had no significant past medical, social, or family history.<br /><br />Initial evaluation showed mild leukocytosis, microcytosis, elevated lipase, and mildly elevated AST/ALT with a negative viral hepatitis panel. A prior CT scan demonstrated gastric wall thickening concerning for gastritis versus malignancy. Repeat imaging showed persistent gastric wall thickening with lymphadenopathy along the gastrohepatic ligament but no pancreatitis. Incidental pulmonary nodules were also noted, and chest CT revealed a perivascular distribution with mild diffuse thoracic lymphadenopathy.<br /><br />Endoscopy showed diffusely severe active gastritis. Gastric biopsy revealed noncaseating granulomas, confirming gastric sarcoidosis. Extensive infectious testing was negative, including H. pylori, T. whipplei, CMV, HSV, EBV, cryptococcus, Bartonella, and tuberculosis. HIV and syphilis serologies were also negative. Biopsy of the pulmonary nodules similarly showed noncaseating granulomas, supporting systemic sarcoidosis. ANA was positive at 1:160 in a speckled pattern, and PTH was 16.<br /><br />He was treated with prednisone and a proton-pump inhibitor, with complete symptom resolution and improvement/resolution of pulmonary nodules on follow-up two months later.<br /><br />The case highlights that gastric sarcoidosis is a rare extrapulmonary manifestation of sarcoidosis, occurring in about 1% of patients. Because it can mimic more common gastrointestinal conditions and even malignancy, clinicians should maintain a broad differential when gastritis is accompanied by atypical imaging findings. Early biopsy and careful interpretation are essential to avoid delayed diagnosis and serious complications such as bleeding, obstruction, or perforation.

Asset Subtitle

Victoria Ogunniyi

Meta Tag

Author List Emmanuel Dike-Udensi, Ethan Molitch-Hou, Monika Stoskute, Victoria Ogunniyi

Category Clinical Vignettes

Concept Gastric Sarcoidosis

Concept Noncaseating Granuloma

Concept Sarcoidosis

Concept Differential Diagnosis

Concept Granuloma

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Victoria Ogunniyi

Track Adult

Keywords

gastric sarcoidosis

noncaseating granulomas

epigastric pain

gastric wall thickening

systemic sarcoidosis

endoscopy

granulomatous gastritis

pulmonary nodules

prednisone treatment

extrapulmonary sarcoidosis

Gastric Sarcoidosis

Noncaseating Granuloma

Sarcoidosis

Differential Diagnosis

Granuloma