Symptomatic pancreatic sarcoidosis

Abstract

Objective: Report the case of female patient with symptomatic pancreatic sarcoidosis. Methods: Case Report. Results: A 65-year-old female was referred for the evaluation of severe fatigability, poor appetite, weight loss over the past two months and abdominal pain. She denied smoking cigarettes or alcohol intake. A review of systems was unremarkable. Her physical exam revealed the abdomen was soft, non-distended and non-tender with normal liver and spleen span. She presented with leukopenia, hypercalcemia, elevated liver enzyme an elevated alkaline phosphatase and an elevated erythrocyte sedimentation rate. An abdominal CT scan demonstrated a pancreatic head mass with retroperitoneal lymph node enlargement Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) were not performed. A CT scan guided pancreatic mass biopsy was performed with uncertain results. Laparoscopic pancreatic biopsy demonstrated noncaseating granulomas with Langerhan giant cells and fibrosis. Both an acid fast bacilli stain and gram stain for a fungal infection were negative. The patient presented elevated Angiotensin converting enzyme levels. Oral prednisone 40 mg daily for 7 days followed by a 7 week tapering schedule was initiated. The patient's signs and symptoms improved abdominal CT scan 6 weeks after treatment revealed no change in the size of the pancreas and peripancreatic lymph nodes. After 8 week of prednisone she remains clinically stable without any abnormal laboratory parameters. Conclusion: Sarcoidosis is a chronic multiorgan disease that uncommonly involves the pancreas. Pancreatic involvement is usually asymptomatic and discovered on autopsy. However, doctors should be cognizant that sarcoidosis can present with symptomatic pancreatic mass, albeit rarely.