%0 Journal Article
%T Granulomatous Pancreatitis in a Patient with Acute Manifested Insulin-Dependent Diabetes Mellitus
%A V¨¢clav Mandys
%A Michal Kheck
%A Michal And¨§l
%J Case Reports in Pathology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/615426
%X Isolated granulomatous noncaseating pancreatitis is a rare condition exceptionally described in human population. We demonstrate a case of the a 71-years-old female patient suffering from recent diabetes mellitus, generalized atherosclerosis and hypertension who died due to pulmonary embolism and terminal bronchopneumonia. Lipomatosis of pancreatic tissue was observed during the postmortem examination. Histological examination of pancreatic tissue discovered multiple small noncaseating epithelioid cell and giant cell granulomas, partly replacing the islets of Langerhans. To our knowledge, our case represents the first description of noninfectious granulomatous pancreatitis associated with acute manifested insulin-dependent diabetes mellitus. 1. Introduction Noncaseating granulomatous inflammation confined to the pancreas has been only exceptionally described in human patients. Infections like tuberculosis and syphilis, exogenous noxes, autoimmunity, and systemic granulomatous diseases are the most frequent causes of granuloma formation within the pancreatic tissue [1]. Abdominal pain or epigastric discomfort, diarrhoea, weight loss, and obstructive jaundice are listed among the clinical symptoms of granulomatous pancreatitis [1¨C3]. We report a case of a patient who clinically presented with acute manifested diabetes mellitus associated with isolated granulomatous pancreatitis discovered in the postmortem examination and we present a review of the available literature. 2. Clinical History A 71-year-old obese woman was admitted with the recent onset of diabetes mellitus manifested as hyperglycaemic ketoacidotic precoma. The past medical history was unremarkable. Recently, arterial hypertension was discovered. Her body weight was 110£¿kg, BMI 38. The plasma glucose level ranged from 3.1 to 15.1£¿mmol/L. The patient was treated with intensified insulin regime. The status of the patient was complicated by intermittent fever and several antibiotics were repeatedly administered. Terminally, clinical signs of septic shock and multiorgan failure appeared and the patient died. Postmortem examination performed 11 hours after death discovered signs of septic shock with activation of spleen pulp and terminal bronchopneumonia. Thromboemboli were found in several peripheral branches of the pulmonary artery. Hypertrophy of the heart (545£¿g), predominantly of the left ventricle, was also observed. The pancreas showed a macroscopically lobular arrangement and lipomatosis; other macroscopic changes were not visible. Lungs, thoracic lymph nodes, and other organs did not show
%U http://www.hindawi.com/journals/cripa/2014/615426/