P0088 - Acute Pancreatitis as the Initial Manifestation of Undiagnosed Sarcoidosis

Award: Presidential Poster Award

Maria Gabriela Rubianes Guerrero, MD¹, Felipe Ignacio Contreras-Yametti, MD², Maria Medina Rojas, MD³, Reka Salgunan, MD¹, Donald P.. Kotler, MD⁴, Sunny Patel, MD^5
1Jacobi Medical Center, Bronx, NY; ²Wellstar Cobb Hospital, Austell, GA; ³Jacobi Medical Center, New York, NY; ⁴Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY; ⁵Albert Einstein College of Medicine, Bronx, NY

Introduction: Involvement of the pancreas in sarcoidosis is rare but has been described before, it can present as pancreatitis or mimic a pancreatic tumor. We describe a case of a woman that was admitted with pancreatitis, found to have mediastinal and hilar lymphadenopathy leading to the diagnosis of sarcoidosis.

Case Description/Methods: A 55-year-old woman presented to the ED complaining of right flank pain radiating to the right upper quadrant for a month. She also reported intermittent fever, chills, weight loss (20 pounds), daily episodes of non-bilious, and non-bloody emesis over three weeks, as well as bilateral blurry vision (worse in right eye) over 1-2 weeks.

Physical exam was notable for right upper quadrant and right costovertebral angle tenderness with mild palpation. Initial laboratory results consisted of leukopenia, and elevated transaminases, lipase was 254 U/L, ACE I was 104 U/L, bilirubin was normal. CT of chest and abdomen showed mediastinal and hilar adenopathy along with ground glass opacities in the peripheral lung fields, acute uncomplicated pancreatitis, and dilation of the pancreatic duct without evidence for acute cholecystitis. MRCP showed areas of stricture and dilation in the pancreatic duct and peripancreatic fat stranding, compatible with acute on chronic pancreatitis. EUS was notable for pancreatic parenchymal changes likely related to recent acute pancreatitis without evidence of irregular pancreatic duct or pancreatic ductal calcifications. There was no evidence of choledocholithiasis, and CBD was not dilated.

Patient received intravenous fluids and analgesics and was started on oral steroids for high suspicion of new presentation of sarcoidosis with pulmonary and extrapulmonary manifestations. She underwent endoscopic bronchial ultrasound, with transbronchial needle aspiration of 3 groups of lymph nodes. Cytology revealed lymphoid tissue with non-caseating granulomas. Despite conventional treatment for pancreatitis, patient’s symptoms didn’t improve. She only reported improvement after 4 weeks of steroids.

Discussion: Pancreatic sarcoidosis is rare and often asymptomatic; however, it can present as pancreatitis, a pancreatic mass mimicking neoplasia, or as a diffusely firm, nodular pancreas. Our patient presented with pancreatitis as the initial manifestation of sarcoidosis and her symptoms improved with steroids, which are the mainstay treatment of sarcoidosis, despite not being recommended for other causes of acute pancreatitis in current guidelines.



Disclosures:


Maria Gabriela Rubianes Guerrero, MD¹, Felipe Ignacio Contreras-Yametti, MD², Maria Medina Rojas, MD³, Reka Salgunan, MD¹, Donald P.. Kotler, MD⁴, Sunny Patel, MD⁵. P0088 - Acute Pancreatitis as the Initial Manifestation of Undiagnosed Sarcoidosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.