[Sarcoidosis--rare cause of an acute pancreatitis]

A 55-year-old patient was admitted to hospital because of acute epigastric pain which could also be felt in the thorax and the left side of the abdomen. After an examination of the lab results, the patient was diagnosed with an acute pancreatitis. In this particular case alcoholic or biliary genesis could be excluded. The pancreatitis progressed in a non-complicated interstitial form. To exclude malignoma as the cause of the pancreatitis, an endosonographic examination was performed. The endosonography showed multiple pathological lymph nodes in the mediastinum, in the region of the truncus coeliacus and the liver hilus. Endosonographic fine needle aspiration of a mediastinal lymph node was not conclusive. A gastroscopic examination excluded a carcinoma of the oesophagus or stomach. An X-ray of the thorax showed inconspicuous results without any trace of bronchial carcinoma. The CT confirmed the endosonographic findings with pathological mediastinal and double sided hilar lymph nodes which also spread to the truncus coeliacus and the hilus of the liver. In order to obtain a representative histology of these lymph nodes - as lymphoma was suspected - a mediastinoscopy was finally performed. The histopathology showed lymphadenitis and epithelioid cell granulomas pointing to sarcoidosis. In summary, sarcoidosis type I in association with an acute pancreatitis was diagnosed. Due to the spontaneous course of the disease, therapy with corticosteroids was not necessary. The patient was recommended to undergo another CT scan after 2 - 3 months.