Differential Diagnosis for Rare Diseases with Gastric Ulcer, Lymph Nodes with Granuloma on Biopsy, and Langhan Giant Cell

• Single Most Likely Diagnosis
  • Sarcoidosis: This condition is characterized by the formation of granulomas in various parts of the body, including the lungs, skin, and lymph nodes. The presence of Langhan giant cells in the biopsy is a hallmark of sarcoidosis. Gastric ulcers can occur in sarcoidosis due to the granulomatous inflammation.
• Other Likely Diagnoses
  • Tuberculosis (TB): TB can cause gastric ulcers and lymph node granulomas with Langhan giant cells. The disease can affect any part of the gastrointestinal tract and is known for its granulomatous inflammation.
  • Crohn's Disease: Although more commonly associated with the small intestine and colon, Crohn's disease can involve the stomach and cause ulcers. Granulomas are a key feature of Crohn's disease, and Langhan giant cells can be present.
• Do Not Miss Diagnoses
  • Lymphoma: Certain types of lymphoma, such as Hodgkin lymphoma, can present with lymph node granulomas and Langhan giant cells. Gastric involvement is less common but can occur. Missing a diagnosis of lymphoma could have severe consequences due to the need for prompt treatment.
  • Infectious Diseases (e.g., Histoplasmosis, Coccidioidomycosis): These fungal infections can cause granulomatous disease with Langhan giant cells and may involve the gastrointestinal tract, including the stomach. They are less common but critical to diagnose due to their potential severity and the need for specific antifungal treatment.
• Rare Diagnoses
  • Eosinophilic Gastroenteritis: This rare condition involves eosinophilic infiltration of the gastrointestinal tract and can cause gastric ulcers. While granulomas are not a primary feature, eosinophilic gastroenteritis can occasionally present with granulomatous changes.
  • Granulomatosis with Polyangiitis (GPA): Formerly known as Wegener's granulomatosis, GPA is a form of vasculitis that can affect various organs, including the gastrointestinal tract. It can cause gastric ulcers and granulomatous inflammation, although this is less common.