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Chronic Diarrhea: A Rare Case of Colonic Sarcoidosis


Farooqui, Samid MD1; Ali, Ijlal Akbar MD1; Nusrat, Salman MD2

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S839
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Introduction: Sarcoidosis is a granulomatous, systemic disease which predominantly affects the pulmonary system. Gastro-intestinal involvement is seen in less than 2% of the cases. Any part of the gastrointestinal tract can be affected, with stomach being the most common organ reported to be affected by sarcoidosis. Colonic involvement is a rare manifestation of the disease and here we present the case of an individual with relapsing diarrhea secondary to underlying colonic sarcoidosis.

Case: We describe the case of a 55-year-old female with no significant past medical history who presented with chronic diarrhea. She reported 6-8 watery bowel movements per day for several months; with additional complaints of worsening shortness of breath and cough. Laboratory work up for infectious etiology was negative. Chest x ray showed bilateral lymphadenopathy which was suggestive of sarcoidosis. A colonoscopy was performed which revealed mild inflammation with and biopsies showing non-caseating granulomas confirming colonic involvement of sarcoidosis. Patient was started on oral steroids with complete resolution of symptoms.

Discussion: Colonic sarcoidosis is a rare entity which commonly presents with abdominal pain, nausea/vomiting, hematochezia, diarrhea and weight loss. The lack of specific radiological and endoscopic manifestations makes it a difficult diagnosis and histopathological analysis is the gold standard to confirm involvement of the GI tract. Symptomatic patients warrant treatment with oral glucocorticoids, with dose adjustment done according to the clinical response, for a minimum of 1 year. Persistent diarrhea in patients with even remote history of chronic pulmonary signs and symptoms should prompt workup for gastrointestinal involvement by this granulomatous disease.

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