Sarcoidosis Presenting With Nephritis and Pancreatitis in a Pediatric Patient: A Rare Case
Sarcoidosis is a multisystem granulomatous disorder of undetermined etiology that usually affects the lungs. It is a rare presentation to have an association between sarcoidosis and pancreatitis. We present a challenging case of acute pancreatitis and kidney dysfunction which had been diagnosed late...
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| Published in: | Curēus (Palo Alto, CA) Vol. 16; no. 10; p. e70635 |
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Cureus
01-10-2024
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| Abstract | Sarcoidosis is a multisystem granulomatous disorder of undetermined etiology that usually affects the lungs. It is a rare presentation to have an association between sarcoidosis and pancreatitis. We present a challenging case of acute pancreatitis and kidney dysfunction which had been diagnosed later to be sarcoidosis. A 12-year-old boy with abdominal pain and weight loss for one month, however, had no respiratory manifestations. Investigations revealed elevated lipase and creatinine. The patient was managed for acute kidney injury with an initial suspicion for autoimmune pancreatitis. Further workup revealed acute interstitial nephritis with non-necrotizing granuloma on renal biopsy. He developed uveitis and was found to have a variant in the angiotensin-converting enzyme (ACE) gene, which led to the diagnosis of sarcoidosis. According to our knowledge, this is the first case with juvenile sarcoidosis involving the pancreas and kidney. |
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| AbstractList | Sarcoidosis is a multisystem granulomatous disorder of undetermined etiology that usually affects the lungs. It is a rare presentation to have an association between sarcoidosis and pancreatitis. We present a challenging case of acute pancreatitis and kidney dysfunction which had been diagnosed later to be sarcoidosis. A 12-year-old boy with abdominal pain and weight loss for one month, however, had no respiratory manifestations. Investigations revealed elevated lipase and creatinine. The patient was managed for acute kidney injury with an initial suspicion for autoimmune pancreatitis. Further workup revealed acute interstitial nephritis with non-necrotizing granuloma on renal biopsy. He developed uveitis and was found to have a variant in the angiotensin-converting enzyme (ACE) gene, which led to the diagnosis of sarcoidosis. According to our knowledge, this is the first case with juvenile sarcoidosis involving the pancreas and kidney. Sarcoidosis is a multisystem granulomatous disorder of undetermined etiology that usually affects the lungs. It is a rare presentation to have an association between sarcoidosis and pancreatitis. We present a challenging case of acute pancreatitis and kidney dysfunction which had been diagnosed later to be sarcoidosis. A 12-year-old boy with abdominal pain and weight loss for one month, however, had no respiratory manifestations. Investigations revealed elevated lipase and creatinine. The patient was managed for acute kidney injury with an initial suspicion for autoimmune pancreatitis. Further workup revealed acute interstitial nephritis with non-necrotizing granuloma on renal biopsy. He developed uveitis and was found to have a variant in the angiotensin-converting enzyme (ACE) gene, which led to the diagnosis of sarcoidosis. According to our knowledge, this is the first case with juvenile sarcoidosis involving the pancreas and kidney.Sarcoidosis is a multisystem granulomatous disorder of undetermined etiology that usually affects the lungs. It is a rare presentation to have an association between sarcoidosis and pancreatitis. We present a challenging case of acute pancreatitis and kidney dysfunction which had been diagnosed later to be sarcoidosis. A 12-year-old boy with abdominal pain and weight loss for one month, however, had no respiratory manifestations. Investigations revealed elevated lipase and creatinine. The patient was managed for acute kidney injury with an initial suspicion for autoimmune pancreatitis. Further workup revealed acute interstitial nephritis with non-necrotizing granuloma on renal biopsy. He developed uveitis and was found to have a variant in the angiotensin-converting enzyme (ACE) gene, which led to the diagnosis of sarcoidosis. According to our knowledge, this is the first case with juvenile sarcoidosis involving the pancreas and kidney. |
| Author | Nazer, Njood Alotaibi, Najla Al Zahrani, Reem A Nashawi, Mohammed Basahl, Emtenan |
| AuthorAffiliation | 2 Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU 5 Pediatrics, King Abdulaziz University Faculty of Medicine, Jeddah, SAU 3 Pediatric Nephrology Center of Excellence, King Abdulaziz University Hospital, Jeddah, SAU 4 Medicine, King Abdulaziz University Hospital, Jeddah, SAU 1 Pediatrics, King Fahad Military Medical Complex, Jeddah, SAU |
| AuthorAffiliation_xml | – name: 4 Medicine, King Abdulaziz University Hospital, Jeddah, SAU – name: 1 Pediatrics, King Fahad Military Medical Complex, Jeddah, SAU – name: 2 Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU – name: 5 Pediatrics, King Abdulaziz University Faculty of Medicine, Jeddah, SAU – name: 3 Pediatric Nephrology Center of Excellence, King Abdulaziz University Hospital, Jeddah, SAU |
| Author_xml | – sequence: 1 givenname: Njood surname: Nazer fullname: Nazer, Njood organization: Pediatrics, King Fahad Military Medical Complex, Jeddah, SAU – sequence: 2 givenname: Reem A surname: Al Zahrani fullname: Al Zahrani, Reem A organization: Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU – sequence: 3 givenname: Najla surname: Alotaibi fullname: Alotaibi, Najla organization: Pediatric Nephrology Center of Excellence, King Abdulaziz University Hospital, Jeddah, SAU – sequence: 4 givenname: Emtenan surname: Basahl fullname: Basahl, Emtenan organization: Medicine, King Abdulaziz University Hospital, Jeddah, SAU – sequence: 5 givenname: Mohammed surname: Nashawi fullname: Nashawi, Mohammed organization: Pediatrics, King Abdulaziz University Faculty of Medicine, Jeddah, SAU |
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| Cites_doi | 10.1590/S1677-5538.IBJU.2019.0042 10.1164/rccm.200402-249OC 10.1016/j.chest.2018.02.003 10.1053/j.ajkd.2006.07.022 10.1093/ndt/gft442 10.1056/NEJMra071714 10.1681/ASN.V391555 10.3748/wjg.v13.i17.2504 10.1001/jama.2011.10 10.1093/oxfordjournals.aje.a009096 10.1038/sj.ki.5001512 10.1097/00042737-199611000-00018 10.3389/fped.2021.724728 10.2214/ajr.182.1.1820015 |
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| Copyright | Copyright © 2024, Nazer et al. Copyright © 2024, Nazer et al. 2024 Nazer et al. |
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| Keywords | nephritis ace pancreatitis sarcoidosis autoimmune |
| Language | English |
| License | Copyright © 2024, Nazer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
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| References | Warshauer DM (ref14) 2004; 182 Rybicki BA (ref3) 1997; 145 Casella FJ (ref10) 1993; 3 Klaus R (ref12) 2021; 9 Iannuzzi MC (ref2) 2007; 357 Newman LS (ref4) 2004; 170 Iannuzzi MC (ref1) 2011; 305 James WE (ref6) 2018; 154 Berliner AR (ref8) 2006; 48 Correia FA (ref13) 2020; 46 Boruchowicz A (ref16) 1996; 8 Rajakariar R (ref9) 2006; 70 Judson MA (ref7) 2012; 29 Harder H (ref15) 2007; 13 Hilderson I (ref11) 2014; 29 Rizzato G (ref5) 2004; 21 |
| References_xml | – volume: 46 year: 2020 ident: ref13 article-title: Renal manifestations of sarcoidosis: from accurate diagnosis to specific treatment publication-title: Int Braz J Urol doi: 10.1590/S1677-5538.IBJU.2019.0042 contributor: fullname: Correia FA – volume: 29 year: 2012 ident: ref7 article-title: The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States publication-title: Sarcoidosis Vasc Diffuse Lung Dis contributor: fullname: Judson MA – volume: 170 year: 2004 ident: ref4 article-title: A case control etiologic study of sarcoidosis: environmental and occupational risk factors publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.200402-249OC contributor: fullname: Newman LS – volume: 154 year: 2018 ident: ref6 article-title: Clinical features of extrapulmonary sarcoidosis without lung involvement publication-title: Chest doi: 10.1016/j.chest.2018.02.003 contributor: fullname: James WE – volume: 48 year: 2006 ident: ref8 article-title: Sarcoidosis: the nephrologist's perspective publication-title: Am J Kidney Dis doi: 10.1053/j.ajkd.2006.07.022 contributor: fullname: Berliner AR – volume: 29 year: 2014 ident: ref11 article-title: Treatment of renal sarcoidosis: is there a guideline? Overview of the different treatment options publication-title: Nephrol Dial Transplant doi: 10.1093/ndt/gft442 contributor: fullname: Hilderson I – volume: 357 year: 2007 ident: ref2 article-title: Sarcoidosis publication-title: N Engl J Med doi: 10.1056/NEJMra071714 contributor: fullname: Iannuzzi MC – volume: 3 year: 1993 ident: ref10 article-title: The kidney in sarcoidosis publication-title: J Am Soc Nephrol doi: 10.1681/ASN.V391555 contributor: fullname: Casella FJ – volume: 13 year: 2007 ident: ref15 article-title: Extrapulmonary sarcoidosis of liver and pancreas: a case report and review of literature publication-title: World J Gastroenterol doi: 10.3748/wjg.v13.i17.2504 contributor: fullname: Harder H – volume: 305 year: 2011 ident: ref1 article-title: Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics publication-title: JAMA doi: 10.1001/jama.2011.10 contributor: fullname: Iannuzzi MC – volume: 145 year: 1997 ident: ref3 article-title: Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization publication-title: Am J Epidemiol doi: 10.1093/oxfordjournals.aje.a009096 contributor: fullname: Rybicki BA – volume: 70 year: 2006 ident: ref9 article-title: Sarcoid tubulo-interstitial nephritis: long-term outcome and response to corticosteroid therapy publication-title: Kidney Int doi: 10.1038/sj.ki.5001512 contributor: fullname: Rajakariar R – volume: 21 year: 2004 ident: ref5 article-title: The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. A 3-year-long prospective observational study publication-title: Sarcoidosis Vasc Diffuse Lung Dis contributor: fullname: Rizzato G – volume: 8 year: 1996 ident: ref16 article-title: Chronic pancreatitis: a complication of sarcoidosis? publication-title: Eur J Gastroenterol Hepatol doi: 10.1097/00042737-199611000-00018 contributor: fullname: Boruchowicz A – volume: 9 year: 2021 ident: ref12 article-title: Case report: pediatric renal sarcoidosis and prognostic factors in reviewed cases publication-title: Front Pediatr doi: 10.3389/fped.2021.724728 contributor: fullname: Klaus R – volume: 182 year: 2004 ident: ref14 article-title: Imaging manifestations of abdominal sarcoidosis publication-title: AJR Am J Roentgenol doi: 10.2214/ajr.182.1.1820015 contributor: fullname: Warshauer DM |
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| Title | Sarcoidosis Presenting With Nephritis and Pancreatitis in a Pediatric Patient: A Rare Case |
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