Granulomatous gastritis due to gastric sarcoidosis presenting as gastric outlet obstruction: Case report of a rare entity.

INTRODUCTION

Granulomatous gastritis (GG) is a rare inflammatory condition affecting the stomach with various aetiologies and non-specific presentation. Sarcoidosis as a cause of GG is even rarer. We describe a rare case of gastric outlet obstruction caused by granulomatous gastritis, the aetiology of which was later identified as sarcoidosis.

CASE PRESENTATION

A 60-year-old female presented with postprandial non-bilious, non-projectile vomiting with loss of appetite and unintentional weight loss. Physical examination revealed significant dehydration, tachycardia, a tender and distended abdomen and palpable liver. Oesophagogastroduodenoscopy (OGD) revealed two gastric ulcers, one each in the fundal and pre-pyloric regions. Gastric biopsy revealed patchy chronic inflammation and few large confluent non-caseating epithelioid granulomas, suggestive of GG. After ruling out tuberculosis, raised serum ACE levels along with anaemia suggested sarcoidosis. The patient was managed with prednisolone, which caused both clinical and pathological resolution.

DISCUSSION

GG commonly presents with symptoms such as weight loss, dyspepsia, early satiety, gastrointestinal bleeding, bloating, and anaemia. Histological examination reveals non-caseating granulomas, which have a varied aetiology. The aetiology should be confirmed by performing an OGD with gastric biopsy. Histopathological findings in sarcoidosis may reveal nodular mucosal irregularities, diffuse erythematous mucosa, deformities in greater or lesser curvatures, and multiple ulcers. The mainstay of treatment of GG due to sarcoidosis includes proton pump inhibitors and glucocorticoids. The prognosis of isolated gastric sarcoidosis is generally good.

CONCLUSION

Granulomatous gastritis is a diagnostic challenge owing to its various aetiologies and non-specific presentation. PPIs and glucocorticoids constitute the mainstay of treatment.