P154 A complex case of granulomatous gastritis

IntroductionGranulomatous gastritis (GG) is a rare inflammatory condition affecting the gastric mucosa, with a prevalence between 0.08% and 0.35%. We were only able to identify one similar reported case of granulomatous gastritis with concomitant sarcoidosis and tuberculosis (TB).MethodsCase reportResultsA 37-year-old gentleman presented in October 2018 with unexplained weight loss, fatigue, post-prandial abdominal pain, and early satiety. He had an eight-pack-year history of smoking and no alcohol intake. There was no significant past medical or family history. Laboratory examinations were within normal limits except for elevated faecal calprotectin of 789 ug/g. Chest X-ray and contrast CT of the thorax, abdomen and pelvis were normal. Urea breath test was negative for H-pylori. Gastroscopy showed non-erosive gastritis with histopathological evidence of granulomatous gastritis. A possibility of Crohn’s Disease (CD) was considered. Subsequent colonoscopy, Video Capsule Endoscopy (VCE) and angiotensin-converting enzyme (ACE) levels were within normal limits. A diagnosis of TB was also considered as TB-Elispot test returned positive and anti-TB medications were commenced. There was no significant improvement in his symptoms. A repeat gastroscopy showed persistent granulomatous inflammation. ACE level was repeated and was elevated (54uL). Serum calcium level was normal, and a review of the CT was negative for lymphadenopathy. He was planned to be started on empirical steroids, suspecting sarcoidosis but it was deferred due to an acute deterioration in renal function (creatine level: 221 mmol/litre). Subsequent renal biopsy showed active tubulo-interstitial nephritis with focal granulomatous inflammation. A working diagnosis of sarcoidosis was established. He was commenced on oral prednisolone (40 mg/day) after evidence of a negative TB-Elispot. There was a significant improvement in his renal function and gastrointestinal symptoms.ConclusionGranulomatous gastritis is a rare form of chronic gastritis, and is most commonly associated with CD (>50%). Sarcoidosis rarely involves the GI tract and isolated gastric sarcoidosis occurs in