SHM Converge Scientific Abstract ePoster Gallery-Better "B"-Lieve It: A Rare Cause of Acute Pancreatitis

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This case describes a 29-year-old man presenting with 2 days of epigastric pain and watery black diarrhea after travel, initially concerning for acute pancreatitis. He reported binge alcohol use during the trip but had no fever, weight loss, jaundice, or clear infectious exposures. Examination showed epigastric tenderness without cervical lymphadenopathy.<br /><br />Initial workup revealed elevated lipase, CRP, ESR, and fibrinogen, with otherwise largely normal labs, including CMP, coagulation studies, lactate, and stool infectious testing. Imaging demonstrated diffuse interstitial pancreatitis, pancreatic duct dilation with abrupt cutoff, and diffuse lymphadenopathy. Because the CBC, LDH, and uric acid were near normal, malignant hematology was initially less concerned. An extensive infectious evaluation for lymphadenopathy was negative. Endoscopic ultrasound/ERCP was then performed, with pancreatic duct stenting and biopsy. Pathology ultimately showed diffuse large B-cell lymphoma.<br /><br />The discussion highlights that pancreatic lymphoma is rare, accounting for less than 0.5–1% of pancreatic malignancies, and pancreatic involvement at diagnosis occurs in only 0.2–2% of non-Hodgkin lymphoma cases. Diffuse large B-cell lymphoma is the most common subtype involved. Patients may present like typical pancreatitis cases, but often lack classic lymphoma symptoms, making diagnosis difficult.<br /><br />The key teaching point is that acute pancreatitis should not automatically be attributed to gallstones or alcohol, especially when the presentation is atypical or imaging shows ductal obstruction and lymphadenopathy. Pancreatic lymphoma is an uncommon but important and often chemotherapy-responsive cause of pancreatitis.

Asset Subtitle

Joshua D. Garcia

Meta Tag

Author List Jessica S. Fuller, Joshua D. Garcia, Scott Taylor

Category Clinical Vignettes

Concept Acute Pancreatitis

Concept Pancreatic Lymphoma

Concept Multi-station lymphadenopathy

Concept Biopsy

Concept Extranodal Non-Hodgkin Lymphoma

Distinguished Non-Finalist

Presenter Organization University of North Carolina at Chapel Hill

Presenting Author Joshua D. Garcia

Track Adult

Keywords

acute pancreatitis

pancreatic lymphoma

diffuse large B-cell lymphoma

epigastric pain

elevated lipase

pancreatic duct dilation

lymphadenopathy

endoscopic ultrasound

ERCP

binge alcohol use

Acute Pancreatitis

Pancreatic Lymphoma

Multi-station lymphadenopathy

Biopsy

Extranodal Non-Hodgkin Lymphoma