Sarcoidosis: Association with small bowel disease and folate deficiency

with small bowel sarcoidosis,3 the association between intestinal sarcoid and villous atrophy is unknown. Crohn's disease and sarcoidosis have common systemic manifestations, and the most frequently occurring cutaneous lesion to be associated with both conditions is erythema nodosum. However, cutaneous granulomas do occur in Crohn's disease, though rarely in areas which are not a direct extension from the gastrointestinal tract or of skin apposition.7 Respiratory tract disease, in the form of bronchial granulomas, has been reported in Crohn's disease but in the affected patients there was no other evidence of lung disease.8 Coexistent Crohn's disease and sarcoidosis has been reported in a few patients,9 and because of their histological and immunological similarities it has been postulated that they may represent an overlapping syndrome of granuloma formation due to a generalised host response to various aetiological agents. However, the existence of non-progressive small bowel disease over two decades, together with a positive Kveim test, is much more compatible with sarcoidosis than Crohn's disease. Io Given the protean nature of sarcoidosis, the generally benign course, and the occurrence of asymptomatic lesions it could be that intestinal disease is commoner than previously thought. Patients with sarcoidosis who present with persistent diarrhoea, malabsorption, or folate deficiency should be investigated for intestinal sarcoidosis, and the diagnosis should be considered in patients with small bowel pathology who later develop manifestations of systemic sarcoidosis.