Sarcoidosis Presenting as Abdominal Pain with Generalised Lymphadenopathy: A Diagnostic Challenge

Sarcoidosis is a chronic multisystem granulomatous disorder of unknown aetiology, characterised by the formation of noncaseating epithelioid granulomas in affected organs. Although pulmonary and intrathoracic lymph node involvement is observed in approximately 90% of cases, extrapulmonary manifestations are increasingly recognised and may affect virtually any organ system, including the liver, spleen, skin, eyes, and heart. Abdominal involvement is present in 10-30% of patients, frequently remaining subclinical or manifesting with non-specific symptoms. Atypical presentations, such as isolated abdominal pain in the absence of respiratory symptoms, create substantial diagnostic challenges and often result in delayed diagnosis or misdiagnosis. Establishing the diagnosis necessitates a high index of clinical suspicion, thorough systemic evaluation and meticulous exclusion of alternative granulomatous conditions, particularly tuberculosis and malignancy. This is a case of 62-year-old female presenting with abdominal pain for last two months and a long history of hypothyroidism and diabetes mellitus. Further, radiological assessment and laboratory findings concluded a diagnosis of multisystem sarcoidosis, which was later managed by corticosteroids for symptomatic systemic sarcoidosis with extensive lymphadenopathy. This case highlights the importance of considering Sarcoidosis as a differential diagnosis in patients presenting with non-specific symptoms and clinical suspicion of granulomatous disease.