Osseous Metaplasia in an Inflammatory Polyp of the Rectum: A Case Report and Review of the Literature.

Osseous metaplasia is a rare finding in colonic neoplasms. We report a case osseous metaplasia in a 74 year-old male who underwent surveillance colonoscopy and found to have a 7 mm rectal polyp. Histopathologic examination revealed an inflammatory polyp with osseous metaplasia.

Sarcoidosis: an extremely rare cause of granulomatous enterocolitis.

Clinically recognizable gastrointestinal (GI) system involvement with sarcoidosis is extremely rare. We present a case of a 51-year-old Caucasian male who was evaluated for abdominal pain, elevated liver enzymes, leukopenia, thrombocytopenia, severe peripheral arthralgias, and chronic watery diarrhea. He had a history of mediastinal and periaortic lymphadenopathy. Extensive laboratory work up for liver diseases, infections, malabsorption and a bone marrow biopsy was essentially unremarkable. Eso-gastroduodenoscopy was unremarkable. Colonoscopy showed scattered right colon ulcerations and erythema. The terminal ileum appeared normal. Biopsies from the duodenum, terminal ileum, and colon showed intramucosal non-caseating granulomas with focal multinucleate giant cell formation in a background of chronic active duodenitis, ileitis, and colitis. Liver biopsy showed moderate non-specific chronic hepatitis with non-caseating granulomas present within portal and lobular parenchyma. The clinical presentations, along with biopsy results were suggestive of sarcoidosis. The patient was started on prednisone and had a significant improvement in his symptoms including diarrhea.

A patient with hemoptysis and renal failure.

Pulmonary-renal syndrome is a medical emergency; etiology of which has broad differential diagnosis. Delay in both diagnosis and initiation of management may result in end-organ damage. Management decisions may have to be empiric till a rapid, definitive tissue diagnosis is established. We present such a case where prompt recognition and immediate treatment was initiated, although the patient sustained irreversible end-organ damage. The case also highlights the need to interpret the kidney biopsy data (namely, immunofluroscence findings) in the context of clinical presentation.