A 58-year-old nonsmoking African American male without any significant past medical history presented to the ER with sudden onset of lower motor neuron type seventh nerve palsy. Routine radiological exam showed additional evidence of bilateral hilar lymphadenopathy and diffuse interstitial infiltrates. The patient's hospital course was complicated by a large amount of hematemesis on the following day. Diagnostic endoscopy and biopsy were performed, which revealed diffuse granulomatous gastritis. A diagnosis of generalized sarcoidosis was made involving the CNS, lungs, and GI tract. He was started on oral steroids as well as proton pump inhibitors and showed a complete resolution of symptoms and pathological findings within 6 weeks of starting therapy. We conclude that other common etiologies of granulomatous gastritis can be ruled out in the background of characteristic roentgenic findings of sarcoidosis. Furthermore, prompt addition of proton pump inhibitors to oral steroids may result in complete resolution of even diffuse granulomatous gastritis presenting with massive hematemesis, thus obviating any surgical intervention.
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