Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10471-10476
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10471
Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis
Masaki Murata, Mitsushige Sugimoto, Yoshihiro Yokota, Hiromitsu Ban, Osamu Inatomi, Shigeki Bamba, Ryoji Kushima, Akira Andoh
Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan
Mitsushige Sugimoto, Hiromitsu Ban, Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan
Ryoji Kushima, Department of Clinical Laboratory Medicine, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan
Author contributions: Murata M, Sugimoto M, Yokota Y, Ban H, Inatomi O, Bamba S, Kushima R and Andoh A collected and analyzed the patient’s clinical data and wrote the paper.
Institutional review board statement: Approval for this case report was not given in advance by the Institutional Review Board of Shiga University of Medical Science.
Informed consent statement: A patient of this case provided informed written consent prior to treatment.
Conflict-of-interest statement: No conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mitsushige Sugimoto, MD, PhD, Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Telephone: +81-77-5482618 Fax: +81-77-5482618
Received: July 26, 2016
Peer-review started: July 28, 2016
First decision: October 11, 2016
Revised: October 17, 2016
Accepted: October 27, 2016
Article in press: October 27, 2016
Published online: December 21, 2016

Gastric sarcoidosis with noncaseating granuloma is rare. Although corticosteroid produces a dramatic clinical response, it is unknown whether azathioprine show efficacy in prednisolone-dependent cases. Here, we report a case of gastric sarcoidosis in a 25-year-old man with severe epigastlargia. Gastroendoscopy revealed multiple map-like ulcerations. Histological examination showed multiple noncaseating granulomatous lesions in gastric mucosa, which were incompatible with diagnoses of Crohn’s disease or tuberculosis. He was started on prednisolone at 30 mg/d, and his symptoms improved within 7-d. The prednisolone was gradually tapered by 5 mg every 2-wk, but oral azathioprine at 50 mg was added after symptoms recurred at tapered dose of 10 mg. Endoscopy 4-wk later showed healing ulcers, and, lymphocytic infiltration was absent. The efficacy of additional azathioprine in gastric sarcoidosis is not well defined. Here, we report a case of prednisolone-dependent gastric sarcoidosis that improved after additional azathioprine, and also review the literature concerning the treatment, especially for prednisolone-dependent cases.

Keywords: Azathioprine, Granulomatous inflammation, Prednisolone, Gastric sarcoidosis, Helicobacter pylori

Core tip: Gastric sarcoidosis is often difficult to detect because of the relative lack of symptoms. Although the abdominal symptoms and endoscopic findings improve in most gastric sarcoidosis cases after corticosteroids, additional therapy, azathioprine, may be required to improve symptoms and to decrease the dosage of prednisolone.