Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 21, 2013; 19(7): 1135-1139
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1135
Gastrointestinal sarcoidosis associated with pneumatosis cystoides intestinalis
Hussein Rahim, Mubashir Khan, Jay Hudgins, Kevin Lee, Lei Du, Louis Amorosa
Hussein Rahim, Mubashir Khan, Kevin Lee, Lei Du, Louis Amorosa, Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08820, United States
Jay Hudgins, Department of Pathology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08820, United States
Author contributions: Rahim H wrote paper, performed literature review. Amorosa L supervised writing paper, literature review, and patient care. Hudgins J provided pathology images and discussion. Khan M assisted in reviewing paper and literature; all authors participated in care of the patient.
Correspondence to: Louis Amorosa, MD, Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 125 Paterson St No. 5100, New Brunswick, NJ 08820, United States. amoroslo@umdnj.edu
Telephone: +1-732-2357219 Fax: +1-732-2358610
Received: September 15, 2012
Revised: December 6, 2012
Accepted: December 15, 2012
Published online: February 21, 2013
Processing time: 160 Days and 1.7 Hours
Abstract

A 39-year-old male reported fevers, weight loss, watery loose stools, and decreased visual acuity in his right eye over the prior five years. He was pancytopenic, had an elevated American council on exercise level, total bilirubin, and alkaline phosphatase. Computed tomography revealed massive hepatosplenomegaly and emphysematous lung changes. Liver biopsy showed non caseating granulomas. The patient was diagnosed with extrapulmonary sarcoidosis and was treated with prednisone. The patient symptomatically improved but 5 mo later presented with abdominal pain caused by perforation of the cecum. He underwent a cecectomy and pathology revealed pneumatosis cystoides intestinalis. This represents the first reported association between pneumatosis cystoides intestinalis and sarcoidosis. The etiology of pneumatosis cystoides intestinalis in this case was likely multifactorial and involved both effects of the corticosteroids as well as the advanced nature of the gastrointestinal sarcoidosis. Furthermore this case has the unique features of emphysematous lung changes and pancytopenia which are uncommon with sarcoidosis.

Keywords: Sarcoidosis; Pneumatosis cystoides intestinalis; Pancytopenia; Emphysema; Corticosteroids