CLINICAL CHALLENGES AND IMAGES IN GI Nausea, Vomiting, and Weight Loss: Common Symptoms of an Uncommon Disease Yutaka Tomizawa,1 Lei Zhao,2 and Leslie W. Yang1 1

Section of Gastroenterology, Hepatology and Nutrition, and 2Department of Pathology, The University of Chicago, Chicago, Illinois

Question: A 36-year-old black woman with no significant past medical history presented with progressive nausea, vomiting, and weight loss for several months. She had no lymphadenopathy or hepatomegaly on physical examination. Laboratory tests showed hemoglobin of 11 g/dL and normal liver functions tests. An esophagogastroduodenoscopy revealed diffuse erythematous, nodular, friable mucosa in the stomach and the antrum was not easily distended on insufflations (Figure A). The pylorus was narrowed but was easily traversed by the endoscope (Figure B). Computed tomography of the abdomen and pelvis showed thickening of the antral wall of the stomach but was otherwise unremarkable (Figure C, arrow). An upper gastrointestinal series confirmed a conical configuration and lack of distension throughout the gastric antrum with patulous pyloric channel (Figure D). Small bowel follow-through showed no evidence of active or chronic inflammatory disease in the small intestine. What is your diagnosis? Look on page 574 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Conflicts of interest The authors disclose no conflicts. © 2014 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2014.04.056

Gastroenterology 2014;147:573–574

CLINICAL CHALLENGES AND IMAGES IN GI Answer to the Clinical Challenges and Images in GI Question: Image 3 (page 573): Gastric Sarcoidosis Pathology findings from the gastric biopsy demonstrated chronic severely active gastritis with noncaseating granuloma formation (Figure E). Additional stains for Helicobacter pylori, acid-fast bacilli, and Grocott’s methenamine silver were negative. Further workup showed CRP

Nausea, vomiting, and weight loss: common symptoms of an uncommon disease.

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