SHM Converge Scientific Abstract ePoster Gallery-Acute Pancreatitis Is a Rare Presentation of This Multisystem Disease

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This case describes a rare presentation of sarcoidosis as hypercalcemia-induced acute pancreatitis. Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown cause, and hypercalcemia occurs in about 10% of patients. Although pancreatitis from hypercalcemia is uncommon, it should be considered because it changes management.<br /><br />A 63-year-old woman with type 2 diabetes, hypertension, and prior cholecystectomy presented with 3 days of abdominal pain, nausea, and non-bloody vomiting. She had epigastric tenderness, elevated lipase (1,723 U/L), acute kidney injury (creatinine 8.9 mg/dL), and mild hypercalcemia (11.9 mg/dL). She improved with standard pancreatitis treatment, with creatinine and calcium normalizing.<br /><br />Workup for the hypercalcemia and pancreatitis initially did not reveal another cause: bone survey, SPEP, PTH, PTHrP, vitamin D, EUS, and MRCP were unrevealing. Two months later, she returned with abdominal pain and weight loss, now with more severe hypercalcemia (13.5 mg/dL), elevated 1,25-OH vitamin D, and high ACE level. PET scan showed widespread hypermetabolic lymphadenopathy, and lymph node biopsy demonstrated non-caseating granulomas with giant cells and focal hyalinization, confirming sarcoidosis after excluding other diagnoses.<br /><br />Her calcium improved with IV fluids and calcitonin, but rose again and responded well to prednisone and hydroxychloroquine.<br /><br />The report emphasizes that sarcoidosis can cause hypercalcemia through increased calcitriol production by activated macrophages, and this may trigger pancreatitis. In sarcoid-related hypercalcemia-induced pancreatitis, corticosteroids are highly effective, and hydroxychloroquine is an option if steroids are not tolerated or ineffective.

Asset Subtitle

Mahrous Abo Hassan

Meta Tag

Author List Mahrous Abo Hassan

Category Clinical Vignettes

Concept Sarcoidosis

Concept Acute Pancreatitis

Concept Hypercalcemia

Concept Noncaseating Granuloma

Concept PTH-independent Calcitriol Production

Distinguished Non-Finalist

Presenter Organization The Ohio State University

Presenting Author Mahrous Abo Hassan

Track Adult

Keywords

sarcoidosis

hypercalcemia

acute pancreatitis

calcitriol

granulomatous disease

non-caseating granulomas

lymphadenopathy

prednisone

hydroxychloroquine

acute kidney injury

Sarcoidosis

Acute Pancreatitis

Hypercalcemia

Noncaseating Granuloma

PTH-independent Calcitriol Production