Intestinal Sarcoidosis: A Diagnostic Conundrum

Sarcoidosis is a systemic granulomatous disorder of unknown cause, most commonly affecting the lungs and intrathoracic lymph nodes. We present the case of a 51-year-old woman in whom intestinal sarcoidosis was incidentally discovered alongside pulmonary involvement. The diagnosis was made during evaluation of trauma-related findings and confirmed through PET-CT, colonoscopy, and biopsy. GI sarcoidosis can closely mimic other granulomatous diseases, such as Crohn's disease or certain infections, making diagnosis particularly challenging. In this case, the presence of mediastinal lymphadenopathy with granulomas and PET-positive uptake in the ascending colon and a lymph node supported the diagnosis. Infectious and inflammatory bowel disease causes were excluded. The patient remained asymptomatic, so treatment was not initiated, consistent with current guidelines that recommend corticosteroids or surgical intervention only for symptomatic or severe disease. Intestinal sarcoidosis, particularly colonic involvement, remains exceedingly rare. However, clinicians should consider it in the differential diagnosis of colonic lesions, especially when imaging reveals evidence of extraintestinal sarcoidosis. Diagnosis relies on histopathological confirmation and the exclusion of other potential causes. Many patients remain asymptomatic and do not require treatment, although corticosteroids, immunomodulators, or surgery may be necessary in symptomatic or complicated cases. Further research is warranted to explore potential associations, such as with gastroesophageal reflux disease, and to determine optimal management strategies.