title: Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis.
abstract: 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.
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Murata
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yokota
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ban
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Inatomi
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Bamba
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kushima
authors.affiliation: Masaki Murata, Yoshihiro Yokota, Osamu Inatomi, Shigeki Bamba, Akira Andoh, Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage*; D001706:Biopsy; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019160:Endosonography; D005773:Gastroscopy; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage*; D012008:Recurrence; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy*; D013272:Stomach Diseases / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine
keywords: Azathioprine; Gastric sarcoidosis; Granulomatous inflammation; Helicobacter pylori; Prednisolone