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Final Program

Other / General Medicine

1314 - Swallowing your Pride: New-onset Dysphagia due to Progressing Sarcoidosis, A Case Report

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Esophageal Dysphagia Secondary to Achalasia from Sarcoidosis Impingement

Case Description: 59 year old male with a PMHx of type II diabetes, possible sarcoidosis diagnosis 2 years prior, was admitted to inpatient rehabilitation due to a right great toe amputation from necrotizing fasciitis. During his stay, he developed esophageal dysphagia causing malnutrition and development of acute kidney injury. Dysphagia was refractory to diet modifications, trials of antireflux medications and osteopathic manipulative treatment. The patient was sent to the emergency department for further workup since the lack of sustenance would impact rehabilitation progression. CT thorax with contrast revealed likely underlying granulomatous disease in the mediastinal and hilar lymph nodes. Esophagogastroduodenoscopy revealed achalasia. Stenosis was refractory to repeated dilations and stent placement. Esophageal lymph node biopsy revealed granulomatosis inflammation. He is currently following with pulmonology to explore treatment options for immunosuppressive therapies in the setting of recovery from a right great toe amputation.

Discussions: This case highlights the importance of escalation of care in the rehabilitation setting, particularly in the setting of dysphagia. Dysphagia is a common complication in rehabilitation settings, commonly due to stroke, traumatic brain injury, medication side effects or structural weakening. Dysphagia can hinder appropriate rehabilitation for multiple reasons, including inability to tolerate a well-balanced diet necessary for proper wound healing and energy maintenance and inability to tolerate oral medications. Extant literature commonly focuses on more common etiologies of dysphagia rather than sarcoidosis-related esophageal dysfunction within the inpatient rehabilitation setting. In this instance, the rehabilitation team identified the need for further diagnostic workup, which led to the discovery of esophageal compression causing dysphagia as a result of worsening sarcoidosis.

Conclusions: This case highlights the importance of recognizing when atypical clinical presentations of dysphagia in the inpatient rehabilitation setting require referral to hospital-based care to appropriately allow patients access to diagnostic resources and specialty consultation.