Abstract
Background: Pancreatic sarcoidosis in the absence of systemic sarcoidosis is a rare entity with few reported cases. Most described cases are in black females and typically involve the head of the pancreas. This report describes a case of sarcoidosis involving the tail of the pancreas in a Caucasian male. Case Presentation: A previously healthy 48 year old Caucasian male presented with abdominal pain following an episode of heavy alcohol ingestion. Serum amylase was elevated and imaging was consistent with acute pancreatitis. Workup ruled out gallstones or autoimmune pancreatitis and his presentation was attributed to alcohol use. Despite abstaining from further alcohol intake, his abdominal pain persisted for several weeks, and subsequent imaging revealed persistent pancreatitis with narrowing of the pancreatic duct in the tail with an associated area of hypoechogenicity. FNA of this region showed rare benign ductal epithelial cells without evidence of malignancy. He was offered resection for his ongoing symptoms and to rule out a malignancy as an underlying etiology. He underwent laparoscopic distal pancreatectomy and splenectomy. Pathology from the resected specimen showed non-necrotizing granulomas involving the pancreas, spleen and the majority of 25 resected lymph nodes. Acid-fast bacteria and Gomori methenamine silver stains were negative for fungal or mycobacterial organisms and there was no evidence of polarizable materials within these granulomas. These findings are consistent with sarcoidosis. The patient recovered and was discharged without complication. He was subsequently referred to a rheumatologist for further workup and management. Conclusions: Sarcoidosis can present with isolated pancreatic symptoms and may be difficult to distinguish from other causes of pancreatitis. In the absence of systemic disease, surgery alone may be both diagnostic and therapeutic.
Highlights
Sarcoidosis is an inflammatory disorder characterized by the presence of granulomatous infiltration of multiple organs, most commonly the lungs, skin, joints or eyes
We report a case of sarcoidosis presenting with pancreatitis in a patient with no known history of sarcoidosis, and we summarize the existing literature to describe the presentation and clinical course of patients with this unusual disease
An otherwise healthy 48 year old Caucasian male presented to the gastroenterology service with complaints of chronic left upper quadrant abdominal pain following an episode of significant alcohol intake 3 months earlier
Summary
Sarcoidosis is an inflammatory disorder characterized by the presence of granulomatous infiltration of multiple organs, most commonly the lungs, skin, joints or eyes. FNA of the hypoechogenic region in the pancreatic tail showed rare benign ductal epithelial cells without evidence of malignancy He continued to have intermittent recurrent exacerbations of abdominal pain which were manageable with dietary restriction to a clear liquid or low-fat diet. Interval surveillance scans 2 and 5 months later showed further decrease of stranding and inflammatory change involving and surrounding the distal pancreatic body and tail and decrease in the pseudocysts, a 7 mm low-density area persisted in the distal pancreatic body with pancreatic duct dilation noted distal to this lesion Given these findings and his ongoing symptoms in the absence of another clear etiology, it was recommended that he undergo resection both to address his symptoms and to rule out. The patient was referred to a rheumatologist for further evaluation
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