Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

World J Gastroenterol. 2016 Dec 21;22(47):10471-10476. doi: 10.3748/wjg.v22.i47.10471.


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; Gastric sarcoidosis; Granulomatous inflammation; Helicobacter pylori; Prednisolone.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Oral
  • Adult
  • Azathioprine / administration & dosage*
  • Biopsy
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Endosonography
  • Gastroscopy
  • Glucocorticoids / administration & dosage*
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Male
  • Prednisolone / administration & dosage*
  • Recurrence
  • Sarcoidosis / diagnosis
  • Sarcoidosis / drug therapy*
  • Stomach Diseases / diagnosis
  • Stomach Diseases / drug therapy*
  • Treatment Outcome


  • Glucocorticoids
  • Immunosuppressive Agents
  • Prednisolone
  • Azathioprine