A cholecystectomy revealing sarcoidosis: A case report

Sarcoidosis is a multisystemic, non-caseating granulomatous disease of unknown etiology, predominantly affecting the lungs and lymph nodes. Gastrointestinal involvement, especially in the gallbladder, is rare. Here, we presented a unique case of granulomatous lymphadenitis in a gallbladder-associated lymph node, revealing systemic sarcoidosis.

A 70-year-old woman with a history of atrial fibrillation, hypertension, and autoimmune gastritis presented with right upper quadrant pain and vomiting. Ultrasound showed multiple gallstones, and laboratory tests revealed elevated liver enzymes. Cholecystectomy was performed, and histopathological examination of the gallbladder specimen revealed granulomas suggestive of sarcoidosis. The patient had a two-month history of dyspnea, cough, and sputum production. Radiologic imaging revealed interstitial lung disease and mediastinal lymphadenopathy, supporting a diagnosis of sarcoidosis. Laboratory tests confirmed elevated ACE levels, and tuberculosis was ruled out.

Sarcoidosis is often asymptomatic or misdiagnosed due to its variable presentations. Involvement of the gallbladder or biliary lymph nodes is exceedingly rare, typically discovered incidentally during cholecystectomy. Histological findings of non-caseating granulomas with asteroid and Schaumann bodies are indicative of sarcoidosis. In endemic regions, tuberculosis must be excluded. Clinical reassessment is crucial to detect symptoms of sarcoidosis following incidental findings.

This rare presentation of sarcoidosis in a biliary lymph node highlights the importance of thorough pathological examination in cases of gallbladder abnormalities with lymph node involvement. A non-caseating granulomas should raise suspicion of sarcoîdosis even in asymptomatic patients.