Rationale: The usual presentation of sarcoidosis is hilar adenopathy, pulmonary reticular opacities, skin, joint, or eye lesions. Pancreatic involvement is unusual and hypercalcemic pancreatitis as initial manifestation is very rare. Patient concerns: We present a case that presented with 1-day history of vomiting, diffuse abdominal pain, and altered mental status. Diagnoses: Initial investigations showed highly elevated calcium levels, acute pancreatitis , and kidney failure. Possible causes entertained were malignancy, hyperparathyroidism, hypervitaminosis D, and granulomatous diseases. Full work-up including a hilar lymph node biopsy revealed noncaseating granuloma. After excluding other diseases capable of producing a similar picture, a diagnosis of sarcoidosis was made. Interventions and outcomes: The patient was started on aggressive intravenous fluid hydration and intravenous calcitonin, after which her altered mental status resolved and both kidney function and hypercalcemia improved. The patient was discharged on oral prednisone and serum calcium level normalized with progressive improvement of kidney function at follow-up. Lessons: 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.
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