S3508 A Rare Presentation of Pancreatic and Colonic Sarcoidosis

Introduction: Pancreatic sarcoidosis is rare, only occurring in 1%-6% of systemic sarcoidosis cases, and its symptoms often mimic more common gastrointestinal (GI) conditions such as pancreatitis and pancreatic carcinoma. We present a case report of pancreatic sarcoidosis in a patient presenting non-specific GI symptoms with a history of complex pancreatic cysts and a family history of pancreatic cancer. Case Description/Methods: A 45-year-old woman with a history of fibromyalgia, opioid dependence, self-reported Crohn’s disease (CD) never on therapy, presented to the Emergency Department due to left upper quadrant abdominal pain radiating to her back for 3 days, with intractable nausea, non-bloody vomiting episodes, and chronic intermittent bloody diarrhea. Her medical history also included a complex cyst of pancreatic tail status post distal pancreatectomy and splenectomy with biopsies showing non caseating granulomas; family history was significant for pancreatic cancer in her father. On admission, the physical exam was normal except for diffuse abdominal tenderness. She denied any respiratory symptoms or skin lesions. Her bloodwork was unremarkable including normal inflammatory/infectious panel and serum angiotensin converting enzyme (ACE). Esophagogastroduodenoscopy showed gastritis, with normal esophagus and duodenum. Colonoscopy reported normal mucosa throughout the colon including terminal ileum (TI), except for 2 polyps in the transverse colon which were removed. Biopsies revealed multiple small, non-necrotizing granulomas on the transverse colon, normal mucosa on the duodenum and TI, and chronic gastritis. A chest computed tomography scan showed prominent mediastinal lymph nodes, and extensive ground glass tree in bud nodularity in both lungs. Following this, pulmonology was consulted, and transbronchial biopsy confirmed the diagnosis of pulmonary sarcoidosis. Pt reported improvement a few days after steroids were started. Discussion: Sarcoidosis is a diagnosis of exclusion, and it mostly relies on symptoms, imaging, pathological confirmation of noncaseating granulomas, and exclusion of similar diseases. This case highlights the effectiveness of corticosteroid therapy and contributes to the limited literature on pancreatic sarcoidosis, emphasizing the importance of considering it in differential diagnoses, especially in patients with non-specific symptoms and ambiguous findings.