Endocrine Abstracts

Introduction: Isolated eosinophilic pancreatitis is very rare disease and usually occurs either as hyperoesinophylia syndrome or as part of eosinophilic gastroenteritis.

Case report: A 55-year-old man presented to his general practitioner (GP) with a 3 week history of flu-like symptoms, pruritis, weight loss and diarrhoea. Initial investigations showed eosinophilia (32.2 ×10⁹/l) and a normal random glucose.

He was seen in a general medical clinic 3 weeks after the initial referral from GP and at this point had polyuria and polydipsia. He was previously well and was on no medication. He denied illicit drug abuse. There had been no recent travel abroad. Physical examination was unremarkable.

Further investigations showed elevated random blood glucose (15.9 mmol/l), raised HbA1c (89 mmol/mol), raised creatinine (171 μmol/l). There were no ova, cysts and parasites in urine or stool. Plasma virology, parasitology and vasculitis screen were negative. A cytogenetic analysis test and F1P1L1-PDGFRA (to rule out eosinophilic leukaemia) was also negative. Computerised Tomography (CT) of chest and abdomen showed a bulky pancreas.

In the context of previous finding, the diagnosis of diabetes mellitus secondary to eosinophilic pancreatitis was established and he was commenced initially on insulin, then prednisolone (40 mg/day). After starting steroids, the eosinophil count fell and insulin requirements decreased. After 2 months, the eosinophilic count was normal and insulin was stopped. Steroids were weaned off over the next 8 weeks. The patient has been off all the treatment for the last 8 months with eosinophil counts just above the normal range and the latest HbA1c of 48 mmol/mol.

Conclusions: We presented a rare case of eosinophilic pancreatitis as part of hyper-eosinophilic syndrome with minimal involvement of other systems. This was a unique situation in which steroids, which usually cause hyperglycaemia, were effectively used to treat diabetes mellitus.