Rare Case of Sarcoidosis with IBD Demonstrates Complexity of Disease

A rare case report of a woman with sarcoidosis in the liver and spleen, who developed signs of inflammatory bowel disease (IBD) during recovery, illustrates that sarcoidosis can occur in less than typical ways.

The study by researchers at the University of Bari Aldo Moro in Italy, titled “A case of sarcoidosis with isolated hepatosplenic onset and development of inflammatory bowel disease during recovery stage,” was published in the journal Autoimmunity Highlights.

A 68-year-old woman who had type 2 diabetes and thyroid insufficiency arrived at the hospital with stomach pain and skin lesions. Her abnormal laboratory values indicated inflammation among other problems.

An ultrasound revealed that her liver and spleen were mildly enlarged and her liver showed signs of fat deposits. A spleen scan revealed several abnormal areas, tested further with computed tomography (CT). In addition to the fatty liver, the examination confirmed the presence of spleen lesions.

The medical team excluded the possibility that her symptoms were caused by bacterial or viral infection. Further magnetic resonance imaging (MRI) suggested that a part of her bile duct was smaller than normal.

A month later, physicians noted a CT scan showing that a lesion had formed in her lung lymph nodes, but again, infection was excluded. Because her bile duct still seemed to be blocked, the team performed a liver biopsy, which finally revealed the basis of her condition.

The tissue contained non-caseating granulomatous lesions and epithelioid and giant cells typical of sarcoidosis. She was treated with methylprednisolone, and two months later her lung and spleen lesions had vanished. Signs of inflammation and the blocked bile duct had improved, and doctors tapered her steroid dose.

Six weeks later, however, she returned to the hospital with stomach pain and chronic diarrhea. Although a colonoscopy had shown her gut mucosa was normal during the initial examinations, parts of it were now heavily inflamed, resembling aspects of Crohn’s disease, an inflammatory bowel disease (IBD). In addition, the inflammation did not seem to be caused by sarcoidosis granulomas.

Doctors again increased the dose of methylprednisolone, and within a couple of days, her diarrhea had improved.

The team noted that cases where sarcoidosis starts in the spleen and liver are rare. Only four previously published reports describe such cases. The development of IBD in association with sarcoidosis is possibly even more rare, particularly since the gut inflammation resolved within days — a response to treatment rarely seen in other patients with IBD.

The researchers said they urge fellow physicians to consider atypical symptoms and “intestinal inflammatory involvement should be seriously considered when the patient experiences symptoms.”