Case Report Describes Rare Sarcoidosis Patient with Hypercalcemia, Pancreatitis

A new case report describes a sarcoidosis patient with pancreatitis — inflammation of the pancreas — and hypercalcemia, or high calcium levels.

The study, “Hypercalcemic pancreatitis a rare presentation of sarcoidosis: A case report,” was published in the journal Medicine.

Sarcoidosis is a complex disease with no known cause. The disease is characterized by bilateral hilar adenopathy (enlarged lymph nodes in the pulmonary hila, or roots), pulmonary shadowing on a chest radiography, granulomas (clusters of inflammatory cells that form in different areas of the body, primarily the lungs, causing inflammation), and lesions in the skin, joints, or eyes.

Pancreatic involvement is uncommon in sarcoidosis, and pancreatitis with hypercalcemia is rare. However, acute elevations of calcium can cause pancreatitis.

Steroids, which are contraindicated in other forms of pancreatitis, are the treatment of choice for these patients.

Researchers at Howard University College of Medicine in Washington, D.C., presented the case of a 53-year-old woman with a medical history of hypertension, type 2 diabetes, and dyslipidemia  — an abnormal amount of fat in the blood.

The patient had been feeling weak for three days with one day of vomiting, diffuse abdominal pain, and an altered mental status. She had been taking vitamin D supplements and medications to treat hypertension and diabetes.

After she was admitted to an intensive care unit (ICU), medical exams showed severe pancreatitis, acute kidney injury, and severe hypercalcemia. She was treated with intravenous fluids for hydration and the thyroid hormone calcitonin, and her mental status and hypercalcemia improved.

A computed tomography (CT) scan of the chest revealed enlarged lymph nodes in the pulmonary hila. She was found to have higher-than-normal levels of vitamin D, parathyroid hormone-related protein (PTHrP), and angiotensin-converting enzyme, which generates the vasoconstrictor angiotensin II.

After conditions were ruled out such as cancer — which may cause elevated calcium levels; encephalopathy, a generic term for any diffuse disease of the brain; hyperparathyroidism, characterized by increased levels of PTHrP and calcium; and hypervitaminosis D, clinicians found noncaseating granulomas — which do not show necrosis, or cell death — in the patient’s lungs.

This led to a diagnosis of sarcoidosis.

The patient was then discharged with oral prednisolone, a corticosteroid. Blood calcium levels normalized and kidney function progressively improved at follow-up appointments.

“Only [five] previous case reports have been described as cases of acute pancreatitis with hypercalcemia in patients with sarcoidosis,” the researchers wrote.

“The current case highlights the need for a high index of suspicion for this condition in patients who present with acute pancreatitis, as steroids are the treatment of choice. Thus, prompt recognition of this entity is of therapeutic significance,” the team concluded.

Researchers emphasized that a careful patient examination for sarcoidosis is particularly important in cases with extrathoracic (outside the chest) or multiple organ involvement.