A case of systemic sarcoidosis with pituitary adrenal insufficiency complicated by eosinophilic gastroenteritis

This paper reports a rare case of coexisting systemic sarcoidosis and eosinophilic gastroenteritis. Multiple inflammatory lesions were detected by computed tomography and (18)F-fluorodeoxyglucose positron emission tomography, and a diagnosis of systemic sarcoidosis was established by biopsies from the hilar lymph node and palpable purpura. The patient exhibited peripheral blood eosinophilia. Upper endoscopy revealed duodenitis, and histological examination confirmed marked eosinophilic infiltration of the duodenal mucosa, consistent with eosinophilic gastroenteritis (EGE). The patient also had hypopituitary adrenal insufficiency, thought to be caused by neurosarcoidosis, based on medical history and evidence of systemic sarcoidosis. Early administration of corticosteroids resulted in improvement without sequelae. Our case suggests that hypereosinophilia and EGE may manifest as a lethal disease phenotype, such as adrenal insufficiency or neurosarcoidosis.