Granulomatous gastritis: a diagnostic dilemma?

Kamani L, Mumtaz K, Azad NS, Jafri W
Correspondence: Dr Lubna Kamani, lubna.kamani@aku.edu

ABSTRACT
Granulomatous inflammation of the gastrointestinal tract is an uncommon entity; an aetiopathogenic diagnosis can be reached only by combining the morphological examination with clinical and laboratory investigations. We report two cases of granulomatous gastritis: a 27-year-old woman presenting with weight loss and a 55-year-old woman presenting with epigastric pain and vomiting. Upper oesophagastroduodenoscopy in these cases showed antral hyperaemia and histopathology showed non-caseating gastric granulomatous inflammation. Both the cases were extensively worked-up for possible tuberculosis (TB) as the patients lived in an endemic area, before starting steroids for the possibility of Crohn's disease (CD) . The first patient improved but the second patient had a flare of underlying undiagnosed TB. Granulomatous gastritis present a diagnostic challenge for treating physicians because of similar clinical, laboratory and endoscopical features between CD and intestinal TB.

Keywords: Crohn’s disease, enteritis, gastritis, gastrointestinal tract inflammation, granulomatous gastritis, tuberculosis
Singapore Med J. 2008; 49(9): e222-4