Clin Endosc > Volume 56(4); 2023 > Article
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Hong, Park, and Baek: Rare cause of granulomatous enteritis

Quiz

A 42-year-old man was referred to our department for the evaluation of multiple polypoid masses with ulcers and hyperemia in the terminal ileum (TI), which was incidentally detected on screening colonoscopy (Fig. 1A, B). The patient had no relevant medical, surgical, or family history. He had no abdominal symptoms, such as nausea, vomiting, diarrhea, or abdominal pain. Physical examination results were unremarkable. Initial laboratory test results, including routine blood tests, liver function tests, carcinoembryonic antigens, and inflammatory markers, were within normal ranges. Both tuberculosis-stimulating specific antigen (interferon-γ) and tuberculin skin tests were negative. Stool studies were negative for ova, parasites, Gram staining, and culture. Examination of the ileocolonoscopic biopsy specimen revealed noncaseating granulomatous inflammation. Contrast-enhanced abdominal computed tomography revealed a polypoid mass in the TI with marked enhancement (Fig. 1C). Regional lymph node enlargement was also observed (Fig. 1D). Positron emission tomography revealed increased fluorodeoxyglucose uptake in the TI and regional lymph nodes (Fig. 1E). Increased fluorodeoxyglucose uptake was also observed in the right upper lobe and mediastinal lymph nodes (Fig. 1F).
Based on this information, what is the most likely diagnosis?
 

NOTES

Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
This work was supported by a clinical research grant from the Pusan National University Hospital in 2022.
Author Contributions
Conceptualization: DHB; Data curation: SMH, BKP; Funding acquisition: DHB; Project administration: DHB; Supervision: BKP, DHB; Writing–original draft: SMH; Writing–review & editing: BKP, DHB.

Fig. 1.
(A, B) Colonoscopy showing multiple polypoid masses with ulcers and hyperemia in the terminal ileum. (C, D) Contrast-enhanced abdominal computed tomography showing a polypoid mass in the terminal ileum with marked enhancement and enlargement of the regional lymph nodes. (E, F) Positron emission tomography scan showing increased fluorodeoxyglucose uptake in the terminal ileum, regional lymph nodes, right upper lobe, and mediastinal lymph nodes.
ce-2023-014f1.jpg
Fig. 2.
Video-assisted thoracic wedge resection of the right upper lobe with mediastinal lymph node dissection. (A) Diffused dense pleural adhesions and anthracotic pigmentation of parenchyma. (B) Pulmonary nodule of the right upper lobe and multiple enlarged conglomerated mediastinal lymph nodes. (C) Resected pulmonary nodule in the right upper lobe.
ce-2023-014f2.jpg
Fig. 3.
Histopathological examination reveals noncaseating granulomatous inflammation in the submucosal layer (hematoxylin and eosin stain, ×400).
ce-2023-014f3.jpg

REFERENCES

1. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007;357:2153–2165.
crossref pmid
2. Rybicki BA, Iannuzzi MC. Epidemiology of sarcoidosis: recent advances and future prospects. Semin Respir Crit Care Med 2007;28:22–35.
crossref pmid
3. Kim DS. Sarcoidosis in Korea: report of the Second Nationwide Survey. Sarcoidosis Vasc Diffuse Lung Dis 2001;18:176–180.
pmid
4. Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001;164(10 Pt 1):1885–1889.
crossref
5. Bulger K, O'Riordan M, Purdy S, O'Brien M, Lennon J. Gastrointestinal sarcoidosis resembling Crohn's disease. Am J Gastroenterol 1988;83:1415–1417.
pmid
6. Veitch AM, Badger I. Sarcoidosis presenting as colonic polyposis: report of a case. Dis Colon Rectum 2004;47:937–939.
crossref pmid
7. Tobi M, Kobrin I, Ariel I. Rectal involvement in sarcoidosis. Dis Colon Rectum 1982;25:491–493.
crossref
8. Ebert EC, Kierson M, Hagspiel KD. Gastrointestinal and hepatic manifestations of sarcoidosis. Am J Gastroenterol 2008;103:3184–3192; quiz 3193.
crossref pmid
9. Sprague R, Harper P, McClain S, Trainer T, Beeken W. Disseminated gastrointestinal sarcoidosis. Case report and review of the literature. Gastroenterology 1984;87:421–425.
crossref pmid
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