1439 A Rare Presentation of Sarcoidosis Diagnosed as Pancreatic Sarcoidosis

Abstract

INTRODUCTION: Sarcoidosis is non caseating granulomatous multi system inflammatory disease of unknown cause affecting many worldwide. In 95% cases, pulmonary and mediastinal lymph nodes are involved. Pancreaticobiliary involvement is exceedingly rare 1-6%. Clinically recognizable gastrointestinal sarcoidosis occurs in 0.1 to 0.9% of patients. Pancreatic sarcoid can mimic clinical and radiological findings associated with tuberculosis and malignancy. CASE DESCRIPTION/METHODS: Here, we present a 50-year-old male patient male with past medical history of diabetes, hypertension, hyperlipidemia and treated syphilis presented to ED with diarrhea, abdominal pain and shortness of breath. Physical exam was significant for hypoxemia with O2 sat 92% on room air and ascites with shifting dullness. Labs were unremarkable including normal lipase ad liver function tests. CTA of chest showed no pulmonary embolism but had enlarged peripancreatic, periceliac, mediastinal lymph nodes with nodular liver. MRCP showed patent pancreatic and biliary duct with right sided compressive atelectasis and nodular contour liver without focal hepatic lesions. No focal masses or inflammatory changes seen within pancreas but showed small focal lesions posterior to pancreas at the level of celiac axis measuring 11 mm and 7 mm read as nonspecific pancreatic lymphadenopathy. EUS directed biopsy of peripancreatic lymph node was significant for non caseating granuloma with negative Acid fast stain and nonmalignant cells. Patient's ascites and oxygenation improved after dexamethasone treatment. DISCUSSION: On literature review patients with pancreatic sarcoidosis have abdominal pain 66%, weight loss 49%, obstructive jaundice 29%, emesis 20%, pruritus 12%, fever 8%, diarrhea 4%, abdominal distention 4% and ascites 4%. Lymphadenopathy is the most common findings on imaging with most common hilar and paratracheal 90% to very uncommon intraabdominal lymphadenopathy 30%. Tissue biopsy of the pancreatic lymph node is required to differentiate pancreatic sarcoidosis from other inflammatory and malignant disorders of the pancreas as laboratory findings are not specific for diagnosis. The prognosis of mild pancreatic sarcoidosis is good and in severe form its variable. Corticosteroid is the drug of choice and remission rate in severe form after stopping is 100%. Non steroidal drugs have been used for treatment of some refractory life-threatening forms of sarcoidosis such as methotrexate, hydroxy chloroquine and azathioprine.